Updates to Set Diabetes Guidelines, Treatment Algorithms

Pharmacy Times 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, once again looking beyond just sugar. And that's really what we have to focus, you know, no longer is diabetes, only about sugar, we have to look at their cardiovascular issue. And that's huge with diabetes. So when we look now to the guidelines, and these are the cardiovascular guidelines that have come out, probably from the end of 2001 to early 2022, we've seen the American Heart Association, the American Stroke Association, the College of Cardiology, and also the kidney guidelines change 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 is actually touting the use of a GLP-1 agonist added to Metformin, granted it's added to Metformin, despite no matter what the agency is, and the reason behind that is the cardiovascular protection, because they're finding specifically from a stroke perspective, we're starting to see that GLP-1 agonist specifically, again, the ones with the cardiovascular benefit. So again, I have to disclose that because not all GLP-1s have cardiovascular benefit. But the ones that do, we're finding that it can actually reduce the incidence of stroke. You know, so many people are afraid of having a stroke, they're actually more afraid of having a stroke than a heart attack. Because you know, heart attack, we think, “Oh, we’ll recover, everything will be fine.” Stroke can leave you debilitated; it can affect your quality of life. And so if we can prevent a stroke, and there's a drug that can help do it for people with diabetes, let's do it. And that's why GLP-1s, regardless of A1C, are being recommended for people that are at high risk of stroke. The other thing too, is 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, I should say, chronic kidney disease or diabetic kidney disease, and we want to slow the progression. And we want to actually improve those people's quality of life. So this is where adding in SGLT-2 inhibitors and folks that are at risk for heart failure. Once again, that's where the SGLT-2 inhibitors so we're looking at the cardiovascular guidelines touting the use of these two drugs, these two classes of drugs, based on what's going on with the patient, you know, so cardiovascular wise, in terms of people at high risk, we're looking at GLP-1s, you know, that's what hypertension and stroke, kidney and heart failure, we're looking more towards the SGLT-2s. And my favorite new guidelines that just came out are from the diabetes, cardio renal metabolic guidelines. So it's the DCRM guidelines. I love it. They have a nice little algorithm that says if your patient has this, you use this agent. So kind of just what I said, if the patient is at high risk for cardiovascular, you're going to go with a GLP-1. If they're at high risk or have heart failure, you're going to use an SGLT-2, and they're very clear-cut guidelines, which really can help practitioners, including pharmacists, making sure the patients are getting the right drug to set them up for success and prevent problems down the road.