Updates to diabetes guidelines and treatment algorithms

Pharmacy hours spoke with Susan Cornell, PharmD, associate director, OEE at Midwestern University College of Pharmacy, about her session at McKesson ideaShare 2022, titled “Diabetes Updates, Guidelines, and Trends.”

Cornell: Yeah, so you know, again, look past the sugar. And that’s really what we need to focus on, you know, diabetes isn’t just about sugar anymore, we need to look at their cardiovascular issue. And that’s huge with diabetes. So when we look now at the guidelines, and these are the cardiovascular guidelines that were published, probably in late 2001 to early 2022, we saw the American Heart Association, the American Stroke Association, the College of Cardiology and kidney guidelines are also changing to recommend the use of SGLT-2s and GLP-1s in people with diabetes, and in some cases, some of them. So, for example, the American Stroke Association actually touts the use of a GLP-1 agonist added to metformin, as long as it’s added to metformin, regardless of the agency, and the reason. behind that is cardiovascular protection, because they’re looking specifically from a stroke perspective, we’re starting to see this GLP-1 agonist specifically, again, those with cardiovascular benefits. Again, I have to disclose this because not all GLP-1s have cardiovascular benefits. But those who do, we find that they can actually reduce the incidence of strokes. You know, so many people are afraid of having a stroke, they are actually more afraid of having a stroke than having a heart attack. Because you know, heart attack, we think, “Oh, we’ll recover, we’ll be fine.” A stroke can make you weak; it can affect your quality of life. And so if we can prevent a stroke, and there’s a drug that can help do that for people with diabetes, let’s do it. And that’s why GLP-1s, independent of A1C, are recommended for people at high risk of stroke. The other thing too is that when we look at the kidney guidelines, they tout the use of SGLT-2 inhibitors to protect the kidneys. So these are people who have chronic kidney disease, should I say, chronic kidney disease or diabetic kidney disease, and we want to slow the progression. And we really want to improve the quality of life of these people. So that’s where SGLT-2 inhibitors and people at risk for heart failure come in. Again, that’s where SGLT-2 inhibitors, so we’re looking at the cardiovascular guidelines touting the use of those two drugs, those two classes of drugs, depending on what’s going on with the patient, you know , so cardiovascular, in terms of high-risk people we look at GLP-1, you know, that’s what hypertension and stroke, kidney and heart failure, we look more at SGLT- 2. And my favorite new guidelines that just came out are the diabetes, cardio-renal metabolic guidelines. So those are the DCRM guidelines. I love it. They have a nice little algorithm that says if your patient has that, you use that agent. So a bit like what I said, if the patient is at high cardiovascular risk, you will opt for a GLP-1. If they’re high-risk or have heart failure, you’re going to use an SGLT-2, and those are very clear guidelines, which can really help practitioners, including pharmacists, to ensure that patients get the right medicine to set them up for success and prevent problems later.

Sharon D. Cole