Type 2 Diabetes

rxfiles.ca/diabetes

Our comprehensive guide to the management of Type 2 Diabetes Mellitus, with a focus on optimizing drug therapy. 

Overview

Medications
(non-insulin)

Insulin

Tools

Trial Summaries

Overview of Diabetes

Introduction

page 2

Welcome to the third edition of RxFiles: Type 2 Diabetes.

Top Diabetes Clinical Pearls

page 3

A collection of learnings, pearls, and things that may surprise you.

Screening, Diagnosis, & Approach to Treatment

page 4

How to screen for T2DM, risk factors for T2DM, diagnosis tree, and an approach to T2DM therapy

PERSPECTIVES ON: Glycemic Targets

page 5

A guide to individualizing glycemic targets for your patient.

Modifiable Risk Factors in Diabetes

page 6

Guidelines and FAQs for blood pressure, lipids, ACEI/ARB, ASA, and lifestyle change.

PERSPECTIVES ON: Lifestyle Change

page 7

Lifestyle change: the best available treatment for type 2 diabetes. 

PERSPECTIVES ON: Diabetes and the Kidneys

page 8

A guide to protecting and preserving the kidneys in diabetes.

PERSPECTIVES ON: Diabetes and Heart Failure

page 9

A guide to comanaging patients with both diabetes and heart failure. 

PERSPECTIVES ON: Diabetes in Pregnancy

page 10

A guide to managing pregnant patients with diabetes.

PERSPECTIVES ON: Diabetes in Older Adults

page 11

A guide to managing older adults with diabetes. 

Pharmacotherapy (non-insulin)

Introduction

page 12

Key messages for using pharmacotherapy in diabetes.

PERSPECTIVES ON: Metformin

page 13

Metformin: first-line, and the backbone of pharmacotherapy. 

Diabetes Drug Comparion Charts

page 14

Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of diabetes pharmacotherapy. 

Weight Loss Pharmacotherapy Chart

page 17

Efficacy, indications, adverse effects, contraindications, drug interactions, monitoring parameters, dosing, and cost comparisons of weight loss pharmacotherapy.

Colour Comparison Chart of Pharmacotherapy

page 18

Side-by-side comparisons of diabetes pharmacotherapy using a 'traffic light' approach.

GLP1 Adverse Effects: Infographic

page 20

Common, less common, rare, and uncertain adverse effects of GLP1 agonists. 

SGLT2 Inhibitor Adverse Effects: Infographic

page 21

Common, less common, rare, and uncertain adverse effects of SGLT2 inhibitors.

Insulin

Introduction

page 22

Key messages for using insulin in diabetes.

Insulin Pens

page 23

Compares and lists the different disposable and reusable insulin pens.

Insulin Comparison Chart

page 24

Side-by-side comparisons of the different BASAL and PRANDIAL insulins available.

Insulin Initiation, Titration, and Follow Up

page 26

How to initiate insulin, injection tips and common mistakes, troubleshooting titration, converting between insulins, using insulin to treat corticosteroid hyperglycemia, and travel tips.

Hypoglycemia and Sick Day Management

page 28

Treating hypoglcyemia, glucagon drug info, and diabetes 'sick day' guidelines. 

PERSPECTIVES ON: Hypoglycemia Risk

page 29

How to assess and address a patient's risk of hypoglycemia.

Self Monitoring of Blood Glucose

page 30

Guidance on how often patients should self monitor blood glucose, and a comparison of available blood glucose meters.

Selecting a Basal Insulin

page 31

Comparison of basal insulins by cost, coverage, convenience, and hypoglycemia.

Diabetes Tools

Introduction

page 32

An overview of the diabetes tools in this book.

Shared Decision Making in Diabetes

page 33

A user-friendly approach to helping patients decide which diabetes therapy might be best for them. 

The Long Story Short - Infographic

page 35

Optimizing the choice and use of insulin needles.

Physical Activity Prescription

page 36

Evidence suggests that prescribing physical activity is more powerful than simply talking to patients about it. 

SADMANS Patient Handout

page 37

A handout guiding patients how to pause, and when to restart, medications that can cause acute kidney injury or other side effects when patients are dehydrated. 

Diabetes Patient Booklet

A patient booklet for patients with type 2 diabetes, designed to motivate patients to exercise, take their medications regularly, test their sugars only when needed, inject insulin properly, and hold SADMANS medications when dehydrated. 

Landmark Diabetes Trials

Introduction

page 38

An overview of the landmark diabetes trials collected here. 

Cardiovascular Outcome Landmark Trials

page 39

Describes the population studied, intervention, A1c achieved, and macrovascular outcomes of landmark diabetes cardiovascular outcome trials. 

Glycemic Target Landmark Trials

page 40

Describes the population studied, intervention, A1c achieved, microvascular outcomes, and macrovascular outcomes of landmark glycemic target trials. 

Insulin Landmark Trials

page 41

Describes the population studied, intervention, efficacy outcomes, and safety outcomes of landmark insulin trials. 

Modifiable Risk Factors Landmark Trials

page 42

Describes the population studied, intervention, and results of landmark lipid, ASA, blood pressure, and diabetes prevention trials.

Abbreviations & Acknowledgements

page 44

Thank you to everyone who helped with the creation of this book!

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