Open Access
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
TLDR
In patients with marked hyperglycemia (A1C 8.5%), antihyperglycemic agents should be initiated concomitantly with lifestyle management, and consideration should be given to initiating combination therapy with 2 agents, 1 of which may be insulin.Abstract:
If glycemic targets are not achieved within 2 to 3 months of lifestyle management, antihyperglycemic pharmacotherapy should be initiated. Timely adjustments to, and/or additions of, antihyperglycemic agents should be made to attain target glycated hemoglobin (A1C) within 3 to 6 months. In patients with marked hyperglycemia (A1C 8.5%), antihyperglycemic agents should be initiated concomitantly with lifestyle management, and consideration should be given to initiating combination therapy with 2 agents, 1 of which may be insulin. Unless contraindicated, metformin should be the initial agent of choice, with additional antihyperglycemic agents selected on the basis of clinically relevant issues, such as contraindication to drug, glucose lowering effectiveness, risk of hypoglycemia and effect on body weight.read more
Citations
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The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.
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TL;DR: The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment, and 4 new recommendations were added and 2 existing recommendations were modified this year.
References
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Journal Article
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34)
R C Turner,Rury R. Holman,Irene M Stratton,Carole A. Cull,David R Matthews,Susan E. Manley,V Frighi,D Wright,Andrew Neil,E M Kohner,H McElroy,C Fox,D R Hadden,Grp Ukpds. +13 more
TL;DR: Since intensive glucose control with metformin appears to decrease the risk of diabetes-related endpoints in overweight diabetic patients, and is associated with less weight gain and fewer hypoglycaemic attacks than are insulin and sulphonylureas, it may be the first-line pharmacological therapy of choice in these patients.
Journal ArticleDOI
10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes
TL;DR: Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up.
Journal ArticleDOI
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
Anushka Patel,Stephen MacMahon,John Chalmers,Bruce Neal,Laurent Billot,Mark Woodward,Mark Woodward,Michel Marre,Mark E. Cooper,Paul Glasziou,Paul Glasziou,Diederick E. Grobbee,Pavel Hamet,Stephen B. Harrap,Simon Heller,Lisheng Liu,Giuseppe Mancia,Carl Erik Mogensen,C. Y. Pan,Neil R Poulter,Anthony Rodgers,Bryan Williams,Severine Bompoint,Bastiaan E. de Galan,Bastiaan E. de Galan,Rohina Joshi,F. Travert +26 more
TL;DR: A strategy of intensive glucose control, involving gliclazide (modified release) and other drugs as required, that lowered the glycated hemoglobin value to 6.5% yielded a 10% relative reduction in the combined outcome of major macrovascular and microvascular events, primarily as a consequence of a 21%relative reduction in nephropathy.
Journal ArticleDOI
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.
David M. Nathan,Patricia A. Cleary,Jye Yu C. Backlund,Saul Genuth,John M. Lachin,Trevor J. Orchard,Philip Raskin,Bernard Zinman +7 more
TL;DR: Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes, and changes between treatment groups remained significant after adjusting for these factors.
Journal ArticleDOI
Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes
Steven E. Nissen,Kathy Wolski +1 more
TL;DR: Patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes mellitus as well as the availability of outcome data for myocardial infarction and death from cardiovascular causes.