{"id":8388,"date":"2023-03-17T14:32:59","date_gmt":"2023-03-17T11:32:59","guid":{"rendered":"https:\/\/gfmg.ua\/new\/?p=8388"},"modified":"2023-03-23T15:39:00","modified_gmt":"2023-03-23T12:39:00","slug":"stop-diabet","status":"publish","type":"post","link":"https:\/\/gfmg.ua\/en\/stop-diabet\/","title":{"rendered":"Practical recommendations for the management of patients with type 2 diabetes. Canada, 2019."},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"8388\" class=\"elementor elementor-8388\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fc0dcd2 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"fc0dcd2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8de98d9\" data-id=\"8de98d9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-944977c elementor-widget__width-auto elementor-widget elementor-widget-image\" data-id=\"944977c\" 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data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-609fb74 elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"609fb74\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">ARTICLE<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-347346d elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"347346d\" data-element_type=\"widget\" data-widget_type=\"theme-post-title.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><a href=\"\">Practical recommendations for the management of patients with type 2 diabetes. Canada, 2019.<\/a><\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6d44dc8 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6d44dc8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-10a3909\" data-id=\"10a3909\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ab05809 elementor-widget elementor-widget-heading\" data-id=\"ab05809\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Clinical practice guidelines for family physicians caring for patients with type 2 diabetes mellitus were released in 2018 by Diabetes Canada.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-f0b1135 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"f0b1135\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-b5914bd\" data-id=\"b5914bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-68524e5 elementor-widget elementor-widget-heading\" data-id=\"68524e5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patients without clinical cardiovascular disease (CVD) who fail to achieve glycemic targets with existing antihyperglycemic drug therapy and in whom reduced risk of hypoglycemia and weight gain are priorities should be considered for add-on treatment with incretin agents (dipeptidyl peptidase IV [DPP-4] inhibitors or glucagonlike peptide\u20131 [GLP-1] agonists) or selective sodium-glucose transporter\u20132 (SGLT-2) inhibitors, as alternatives to insulin secretagogues, insulin, and thiazolidinediones (TZDs).\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f44636e elementor-widget elementor-widget-heading\" data-id=\"f44636e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patients without clinical cardiovascular disease (CVD) who fail to achieve glycemic targets with existing antihyperglycemic drug therapy should additionally receive an antihyperglycemic agent with demonstrated cardiovascular (CV) outcome benefit (such as empagliflozin or liraglutide) to decrease the likelihood of major CV events.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a058e4 elementor-widget elementor-widget-heading\" data-id=\"6a058e4\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">In patients who fail to achieve glycemic targets with existing noninsulin antihyperglycemic drug therapy, consider adding a once-daily basal insulin regimen as an alternative to premixed insulin or bolus-only regimens, as a means of reducing weight gain and hypoglycemia.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-1dafc73\" data-id=\"1dafc73\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d7013a4 elementor-widget elementor-widget-image\" data-id=\"d7013a4\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"722\" height=\"638\" src=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/stop_diabetes-1-e1679051843905.png\" class=\"attachment-full size-full wp-image-8375\" alt=\"\" srcset=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/stop_diabetes-1-e1679051843905.png 722w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/stop_diabetes-1-e1679051843905-600x530.png 600w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/stop_diabetes-1-e1679051843905-64x57.png 64w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/stop_diabetes-1-e1679051843905-300x265.png 300w\" sizes=\"(max-width: 722px) 100vw, 722px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-414e282 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"414e282\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-4253383\" data-id=\"4253383\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d4d9526 elementor-widget elementor-widget-heading\" data-id=\"d4d9526\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">To decrease the likelihood of nocturnal and symptomatic hypoglycemia, long-acting insulin analogues should be considered as an alternative to neutral protamine Hagedorn (NPH) insulin.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6caf0da elementor-widget elementor-widget-heading\" data-id=\"6caf0da\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patients receiving insulin who fail to achieve glycemic targets should undergo dose adjustment or the administration of additional antihyperglycemic medication (noninsulin or bolus insulin), with the following kept in mind:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4379cdf elementor-widget elementor-widget-html\" data-id=\"4379cdf\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>To achieve better glycemic control with weight loss and a lower hypoglycemia risk than with single- or multiple-bolus insulin injections, consider administering a GLP-1 agonist as add-on treatment prior to initiating bolus insulin or intensifying insulin therapy<\/li>\n        <li>Consider add-on therapy with an SGLT-2 inhibitor as a means of improving glycemic control with weight loss and reducing the likelihood of hypoglycemia, compared with the administration of additional insulin<\/li>\n        <li>Consider add-on therapy with a DPP-4 inhibitor as a means of improving glycemic control without weight gain or greater likelihood of hypoglycemia, compared with the administration of additional insulin<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a0eaf01 elementor-widget elementor-widget-heading\" data-id=\"a0eaf01\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">All persons with diabetes should engage in a comprehensive, multifaceted approach to CV risk reduction, including the following:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ba8ef6c elementor-widget elementor-widget-html\" data-id=\"ba8ef6c\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Hemoglobin A1c (HbA1c) target of \u22647.0% instigated early in the course of diabetes<\/li>\n        <li>Systolic and diastolic blood pressure (BP) of &#60;130 mm Hg and &#60;80 mm Hg, respectively<\/li>\n        <li>Additional vascular protective medications in most adults with diabetes<\/li>\n        <li>Reaching and maintaining a healthy weight<\/li>\n        <li>Engaging in healthy nutrition<\/li>\n        <li>Regular physical activity<\/li>\n        <li>Smoking cessation<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07ac45f elementor-widget elementor-widget-heading\" data-id=\"07ac45f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">To lower the CV risk in adults with type 1 or type 2 diabetes, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) should be employed at vascular-protective doses when any of the following exist (note: among women with childbearing potential, ACE inhibitors, ARBs, or statins should be used only in the presence of reliable contraception):\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b5508c5 elementor-widget elementor-widget-html\" data-id=\"b5508c5\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Clinical CVD<\/li>\n        <li>Age >55 y with an additional CV risk factor or end organ damage (albuminuria, retinopathy, left ventricular hypertrophy)<\/li>\n        <li>Microvascular complications<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e277f16 elementor-widget elementor-widget-heading\" data-id=\"e277f16\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">To prevent CV events in patients with established CVD, employ low-dose acetylsalicylic acid (ASA) therapy (81-162 mg).\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f5d209d elementor-widget elementor-widget-heading\" data-id=\"f5d209d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The failure of existing antihyperglycemic drug therapy to achieve glycemic targets In adults with type 2 diabetes with clinical CVD should prompt the addition of an antihyperglycemic agent with demonstrated CV outcome benefit (such as empagliflozin or liraglutide) to lower the risk of major CV events.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0a15190 elementor-widget elementor-widget-heading\" data-id=\"0a15190\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The failure of existing antihyperglycemic drug therapy to achieve glycemic targets in older people with type 2 diabetes who have no other complex comorbidities (but who do have clinical CVD) can prompt the addition of an antihyperglycemic agent with demonstrated CV outcome benefit (such as empagliflozin or liraglutide) to lower the risk of major CV events.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ca472e7 elementor-widget elementor-widget-heading\" data-id=\"ca472e7\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Interprofessional teams should provide collaborative care for individuals with diabetes and depression to improve the following:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be613e8 elementor-widget elementor-widget-html\" data-id=\"be613e8\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Depressive symptoms<\/li>\n        <li>Adherence to the use of antidepressant and noninsulin antihyperglycemic medications<\/li>\n        <li>Glycemic control<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e87454b elementor-widget elementor-widget-heading\" data-id=\"e87454b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Psychosocial interventions, including the following, should be woven into diabetes care plans:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-67d7fcd elementor-widget elementor-widget-html\" data-id=\"67d7fcd\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>Motivational interventions<\/li>\n        <li>Stress management strategies<\/li>\n        <li>Coping skills training<\/li>\n        <li>Family therapy<\/li>\n        <li>Case management<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-086a988 elementor-widget elementor-widget-heading\" data-id=\"086a988\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">To achieve better glycemic control and lower the risk of CVD and overall mortality, patients with diabetes should, over the course of at least 3 days per week, engage in a minimum of 150 minutes of moderate- to vigorous-intensity aerobic exercise, with no more than 2 consecutive nonexercise days. Glycemic control can also be aided, though to a lesser extent, by 90-140 minutes per week of exercise or planned physical activity.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ed5bf34 elementor-widget elementor-widget-heading\" data-id=\"ed5bf34\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">In patients with type 2 diabetes who are able to perform interval training, this form of physical activity (in which short periods of vigorous exercise are alternated with short recovery periods employing low to moderate intensity or rest) can be recommended to aid cardiorespiratory fitness.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1f2722c elementor-widget elementor-widget-heading\" data-id=\"1f2722c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Resistance exercise should be performed by patients with diabetes, including elderly ones, two or (preferably) three times per week.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0a8fb32 elementor-widget elementor-widget-heading\" data-id=\"0a8fb32\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">As a means of increasing physical activity and improving HbA1c levels, a patient with diabetes and his\/her health-care provider should collaborate on setting exercise goals, resolving potential barriers to exercise, and determining where and when the patient should exercise, with self-monitoring performed.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bf9f97b elementor-widget elementor-widget-heading\" data-id=\"bf9f97b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p 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