Did you know that people with type 2 diabetes having chronic kidney disease are at an increased risk of hypoglycemia?

Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Alice Cheng, an Endocrinologist at Credit Valley Hospital in Mississauga, and St. Michael's Hospital in Toronto. She is also an Associate Professor in the Department of Medicine at the University of Toronto and the current the Chair of the Professional Section of Diabetes Canada and Associate Editor for the Canadian Journal of Diabetes.

This episode discusses best practices on how to manage type 2 diabetes in those having renal impairment. Our experts take a deeper dive into talking points when communicating with such patient groups, as well as therapeutic considerations to lower the risk of hypoglycemia when choosing an appropriate basal insulin for those having kidney disease.

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The views and opinions expressed in this episode are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Declaration of conflict of interest:

Dr. Goldenberg:

• Direct financial relationship including receipt of honoraria: Abbott, Agora, Amgen, Antibody, AstraZeneca, Bayer, Boehringer Ingelheim, CCRN, CMSKTRG, Eli Lilly, EOCI, HIT Global, HLS, Inceptus, Janssen, LiV, Master Clinician Alliance, MD Briefcase, Merck, Mylan, Novo Nordisk, Sanofi, Script Medical, Servier, STA, Takeda, Toronto Knowledge Translation Working Group, Unik, Valeant. Membership on advisory boards or speaker’s bureau: Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS, Janssen, Merck, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi. 

Dr. Cheng:

• Direct financial relationship including receipt of honoraria: Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, Insulet, HLS Therapeutics, Janssen, Novo Nordisk, Sanofi, Takeda, Antibody, EOCI, Six Degrees, Liv, CPD Network, Canadian Collaborative Research Network, Master Clinical Alliance, Canadian Medical & Surgical Knowledge Translation Research Group, Sea Courses, Alliance of Best Practices in Health Education, Partners in Progressive Medical Education, Agence Unik, MD Briefcase, LMC Physician Inc., Meducomm, Humber Hospital, Timed Right, The ACADEMY. Membership on advisory boards or speaker’s bureau: Abbott, Amgen, Astra Zeneca, Bayer, Bausch, Boehringer Ingelheim, Dexcom, Eli Lilly, GSK, HLS Therapeutics, Insulet, Janssen, Merck, Medtronic, Novo Nordisk, Pfizer, Sanofi, Takeda. Funded grants, research or clinical trials: Applied Therapeutics, Sanofi.

With newer technologies being used to monitor blood glucose levels, how can we use data from continuous glucose monitoring (CGM) to inform the day-to-day management of diabetes?

Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Ms. Lori Berard, a Registered Nurse and Certified Diabetes Educator currently working as a Nurse Clinical Research Consultant in Winnipeg. She has authored several chapters in recent Diabetes Canada Clinical Practice Guidelines, notably the 2018 Guidelines on Monitoring Glycemic Control and the 2021 Update for Blood Glucose Monitoring in Adults and Children with Diabetes.

This episode discusses the technical and practical aspects of CGM use and how these newer technologies are changing diabetes care. Our experts touch on the differences between real-time and intermittently scanned CGM, and further explore the clinical relevance of key parameters such as time-in-range (TIR), time-below-range (TBR), and coefficient of variation (CV). They provide practical tips on interpreting ambulatory glucose profiles (AGP) and discuss the benefits and positive impact CGM and metrics beyond HbA1c have had in facilitating shared care in diabetes management.

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The views and opinions expressed in this episode are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Declaration of conflict of interest:

Dr. Goldenberg:

• Direct financial relationship including receipt of honoraria: Abbott, Agora, Amgen, Antibody, AstraZeneca, Bayer, Boehringer Ingelheim, CCRN, CMSKTRG, Eli Lilly, EOCI, HIT Global, HLS, Inceptus, Janssen, LiV, Master Clinician Alliance, MD Briefcase, Merck, Mylan, Novo Nordisk, Sanofi, Script Medical, Servier, STA, Takeda, Toronto Knowledge Translation Working Group, Unik, Valeant. Membership on advisory boards or speaker’s bureau: Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS, Janssen, Merck, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi.

Ms. Berard:

• Direct financial relationship including receipt of honoraria: Quanta Dialysis Ltd. Membership on advisory boards or speaker’s bureau: Eli Lilly, Sanofi, Novo Nordisk, Abbott, BD, MontMed, Bayer, DEXCOM: Bayer, AstraZeneca, Boehringer Ingelheim, Roche, HLS Therapeutics.

Fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA) have demonstrated maintenance of HbA1c efficacy, less hypoglycemia, and weight loss compared to basal-bolus insulin therapies in previous trials, but what is the latest evidence comparing these strategies in those with type 2 diabetes?

Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Jeremy Gilbert, an endocrinologist at the Sunnybrook Health Sciences Centre and Associate Professor at the University of Toronto Department of Medicine. He has authored chapters in recent Diabetes Canada Clinical Practice Guidelines and is the national lead for dissemination and implementation for the current guidelines. He is also an executive and national editor for the Canadian Journal of Diabetes, and the endocrinology section chair at the Royal College and Surgeons of Canada.

This episode discusses data from several studies recently presented at the ADA 2022 Scientific Sessions comparing fixed-ratio combinations of basal insulin and GLP-1 RA vs. basal-bolus regimens in type 2 diabetes, including the SoliSimplify and SoliComplex Real-World Studies, and the IDegLira HIGH Trial.

The SoliSimplify and SoliComplex Studies directly compared iGlarLixi (insulin glargine 100 U/mL and lixisenatide) vs. a basal-bolus regimen in those with type 2 diabetes advancing from basal insulin therapy, evaluating HbA1c and body weight outcomes, and treatment persistence and adherence outcomes, respectively. The IDegLira HIGH Trial compared the efficacy and safety of IDegLira (insulin degludec and liraglutide) vs. a basal-bolus regimen in those with poorly controlled type 2 diabetes and very high HbA1c. Our experts also dive into the relevance and applicability of these recent study findings to clinical practice.

Don’t miss the conversation!

The views and opinions expressed in this episode are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Declaration of conflict of interest:

Dr. Goldenberg:

• Direct financial relationship including receipt of honoraria: Abbott, Agora, Amgen, Antibody, AstraZeneca, Bayer, Boehringer Ingelheim, CCRN, CMSKTRG, Eli Lilly, EOCI, HIT Global, HLS, Inceptus, Janssen, LiV, Master Clinician Alliance, MD Briefcase, Merck, Mylan, Novo Nordisk, Sanofi, Script Medical, Servier, STA, Takeda, Toronto Knowledge Translation Working Group, Unik, Valeant. Membership on advisory boards or speaker’s bureau: Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS, Janssen, Merck, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi. 

Dr. Gilbert:

• Membership on advisory boards or speaker’s bureau: Abbott, Astra Zeneca, Amgen, Bayer, Boerhringer, Dexcom, Eli Lilly, HLS therapeutics, Janssen, Phizer, Novo Nordisk, Sanofi.

Metrics beyond HbA1c such as glucose variability are emerging as key parameters that can help guide the daily management of diabetes, but what is the clinical relevance of such measures, particularly for those with diabetes taking basal insulin?

Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Tadej Battelino, Professor, Head, and Chair of Pediatrics at the University of Ljubljana Faculty of Medicine, and Head of the Department of Pediatric and Adolescent Endocrinology at the UMC Ljubljana.

There has been limited data on the utility of CGM as an outcome measure in clinical practice and a lack of evidence on the use of CGM to compare second-generation basal insulin analogues glargine 300 U/mL (Gla-300) and degludec 100 U/mL (IDeg-100). InRange was the first randomized controlled trial to compare Gla-300 and IDeg-100 in adults with type 1 diabetes using CGM data to assess time-in-range (TIR) as the primary endpoint.

This episode discusses the within-day and between-day glucose variability data from the InRange study comparing Gla-300 and IDeg-100, of which Dr. Battelino was the primary investigator. Our experts also dive into the topics of why glucose variability should be a parameter of greater consideration, with a focus on coefficient of variation.

Don’t miss the conversation!

The views and opinions expressed in this episode are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Declaration of conflict of interest:

Dr. Goldenberg:

• Direct financial relationship including receipt of honoraria: Abbott, Agora, Amgen, Antibody, AstraZeneca, Bayer, Boehringer Ingelheim, CCRN, CMSKTRG, Eli Lilly, EOCI, HIT Global, HLS, Inceptus, Janssen, LiV, Master Clinician Alliance, MD Briefcase, Merck, Mylan, Novo Nordisk, Sanofi, Script Medical, Servier, STA, Takeda, Toronto Knowledge Translation Working Group, Unik, Valeant. Membership on advisory boards or speaker’s bureau: Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS, Janssen, Merck, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi. 

Dr. Battelino:

• Membership on advisory boards or speaker’s bureau: Novo Nordisk, Sanofi, Eli Lilly, Boehringer-Ingelheim, Medtronic, Indigo Diabetes, AstraZeneca, Sanofi, Roche. Funded grants, research or clinical trials: Abbott Diabetes Care, Medtronic, Novo Nordisk, Sanofi, Sandoz, Novartis. Other financial relationships/investments: owns stocks of DreaMed Diabetes.

Continuous glucose monitoring (CGM) metrics are emerging as key parameters that can help guide the management of diabetes, but how can they be applied in clinical practice, particularly for those with diabetes taking basal insulin?

Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Tadej Battelino, Professor, Head, and Chair of Pediatrics at the University of Ljubljana Faculty of Medicine, and Head of the Department of Pediatric and Adolescent Endocrinology at the UMC Ljubljana. Dr. Battelino also most notably led the 2019 International Consensus in Time in Range.

There has been limited data on the utility of CGM as an outcome measure in clinical practice and a lack of evidence on the use of CGM to compare second-generation basal insulin analogues glargine 300 U/mL (Gla-300) and degludec 100 U/mL (IDeg-100). InRange was the first randomized controlled trial to compare Gla-300 and IDeg-100 in adults with type 1 diabetes using CGM data to assess time-in-range (TIR) as the primary endpoint.

This episode discusses study design, key findings, and clinical implications from the InRange trial, of which Dr. Battelino was the primary investigator. Our experts also discuss the importance of CGM metrics such as TIR and coefficient of variation, and the practical relevance of using these markers to help people with diabetes establish personalized targets and proactively manage highs and lows to improve glycemic control.

Don’t miss the conversation!

The views and opinions expressed in this episode are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Declaration of conflict of interest:

Dr. Goldenberg:

• Direct financial relationship including receipt of honoraria: Abbott, Agora, Amgen, Antibody, AstraZeneca, Bayer, Boehringer Ingelheim, CCRN, CMSKTRG, Eli Lilly, EOCI, HIT Global, HLS, Inceptus, Janssen, LiV, Master Clinician Alliance, MD Briefcase, Merck, Mylan, Novo Nordisk, Sanofi, Script Medical, Servier, STA, Takeda, Toronto Knowledge Translation Working Group, Unik, Valeant. Membership on advisory boards or speaker’s bureau: Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, HLS, Janssen, Merck, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novo Nordisk, Sanofi. 

Dr. Battelino:

• Membership on advisory boards or speaker’s bureau: Novo Nordisk, Sanofi, Eli Lilly, Boehringer-Ingelheim, Medtronic, Indigo Diabetes, AstraZeneca, Sanofi, Roche. Funded grants, research or clinical trials: Abbott Diabetes Care, Medtronic, Novo Nordisk, Sanofi, Sandoz, Novartis. Other financial relationships/investments: owns stocks of DreaMed Diabetes.