Diving Into Diabetes

Hypoglycemia associated with commonly used diabetes medications can be distressing and potentially lethal. What are the latest recommendations on prevention and treatment of hypoglycemia from the Diabetes Canada Clinical Practice Guidelines (CPG)? Our host, Dr. Alexandria Ratzki-LeeWing, takes a deeper look into this topic together with Dr. Stewart Harris, a family doctor and professor at Western University in London. This episode discusses highlights from the 2023 CPG chapter updates on hypoglycemia in adults. Our speakers explore how guidance on hypoglycemia has evolved in these new recommendations, and its impact on diabetes care for both people living with diabetes and clinicians. They also touch on practical strategies to reduce hypoglycemia risk, and offer their perspectives on topics that may be expanded on in future CPG iterations. 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. Ratzki-LeeWing Dr. Harris: MAT-CA-2400059

Diabetes remission is a concept that has been gaining attention as new treatments and interventions become available in the Diabetes Canada Clinical Practice Guidelines. How do we define diabetes remission, and what strategies can we employ to sustain it once it has been attained? Our host, endocrinologist Dr. Hertzel Gerstein, professor of medicine at McMaster University and Hamilton Health Sciences, takes a deeper look into this topic with Dr. Kaberi Dasgupta, a physician scientist and professor of medicine at McGill University and the McGill University Health Centre. This episode explores the latest updates from the Diabetes Canada Clinical Practice Guidelines on remission of type 2 diabetes (T2D) and other new approaches in development. In their discussion, they detail the definition of remission in diabetes and what it means for the patient, before explaining the importance of early intervention in T2D. Together, they review two approaches included in the Canadian clinical practice guidelines to achieving remission: bariatric surgery and low-energy diets. They also discuss the importance of sustaining weight loss by continuing to adhere to the same healthy diet and lifestyle modifications that were implemented to attain remission. Ongoing research efforts focused on prevention, treatment, and remission of diabetes continue to emerge, with more discoveries expected in the future. 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. Gerstein Dr. Dasgupta: MAT-CA-2300840

Numerous challenges afflict patients with type 1 diabetes (T1D) throughout their disease journey. How can newer, more innovative management approaches help patients overcome these challenges? This episode discusses the challenges that regularly burden patients with T1D, and how recent technological breakthroughs, such as automated insulin pumps and continuous glucose monitoring (CGM), have been transformative in diabetes management. Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Bruce Perkins, Professor, Endocrinologist, Epidemiologist, and Clinician Scientist in the Faculty of Medicine and the Institute for Health Policy Management and Evaluation at the University of Toronto, and Director of Leadership at the Sinai Centre for Diabetes. Together, they provide practical advice for patients and their healthcare team in managing T1D and discuss emerging developments that have the potential to shift the treatment paradigm in diabetes care. 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. Ronald Goldenberg: Dr. Bruce Perkins: MAT-CA-2300841

With the abundance of various glucose monitoring technologies, how can healthcare providers guide patients with type 2 diabetes (T2D) toward the most appropriate choice? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Ilana Halperin, Endocrinologist at Sunnybrook Health Sciences Centre and Assistant Professor at the University of Toronto. This episode discusses the limitations of previous-generation glucose monitoring devices and highlights the advantages of continuous glucose monitoring (CGM) with an emphasis on the most important parameters, namely time-in-range (TIR), time-below-range (TBR), and coefficient of variation (CV). The importance of clinical trials is discussed, namely, the IMMEDIATE and two-part MOBILE studies in the context of CGM for T2D. The IMMEDIATE study examined the efficacy of intermittently scanned CGM in patients with T2D using non-insulin therapies. The MOBILE Phase 1 study explored the impact of CGM discontinuation after 8 months of use in adults with T2D treated using basal insulin without bolus insulin. Similarly, the MOBILE Phase 2 study assessed the effectiveness of CGM in adults with T2D treated with both basal insulin and bolus insulin in primary care practices. 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. Ronald Goldenberg: Dr. Ilana Halperin: MAT-CA-2300748

Hypoglycemia is a major concern for people living with diabetes; however, there are numerous myths and misconceptions surrounding its role in diabetes management. What are the common misunderstandings about hypoglycemia in diabetes care? Our host, Dr. Alexandria Ratzki-LeeWing, takes a deeper look into this topic together with Dr. Stewart Harris, a family doctor and professor at Western University in London. This episode explores the impact of hypoglycemia on individuals with diabetes, and examines its consequences and associated risks in everyday life. In the past decade, real-world evidence has emerged, with long-term prospective studies indicating an alarmingly high burden of severe hypoglycemia. Our speakers today cover practical strategies for preventing and managing hypoglycemia in patients with diabetes, such as patient education on identifying low blood glucose symptoms and promoting effective self-management. Other approaches discussed include employing newer therapies with reduced hypoglycemia risk or safer long-acting basal insulin, and leveraging technology such as continuous glucose monitors (CGMs) combined with regular consultations for optimal use. 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. Ratzki-LeeWing Dr. Harris: MAT-CA-2300744

Titration is a crucial element for individuals with diabetes taking basal insulin to achieve their glycemic targets, so how do we ensure we’re doing it optimally? Our host, Dr. Ronald Goldberg, takes a deeper look into this topic with Dr. Irene Hramiak, a Professor of Medicine at Western University, and the current Department of Medicine Site Chief and Endocrinologist at St. Joseph’s Hospital. This episode discusses the history of basal insulin titration and how standard protocols have changed over time, with new advances brought on by clinical evidence from trials like the INSIGHT study, and patient empowerment. Our experts also take a deeper look into the recent LixiLan ONE CAN study, of which Dr. Hramiak was the primary investigator: Comparing a daily versus weekly titration algorithm in people with type 2 diabetes switching from basal insulin to iGlarLixi in the LixiLan ONE CAN randomized trial. 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. Hramiak: Membership on advisory boards or speaker’s bureau including receipt of honoraria: CCRN, Canadian Medical & Surgical Knowledge Translation Research Group, Boehringer Ingelheim/Eli Lilly (BI-LILLY joint venture), Eli Lily & Co, Insulet Corp, Medtronic, Merck & Co Inc, Novo Nordisk, Sanofi-Aventis, Western University. Membership on advisory boards or speaker’s bureau: CCRN, Canadian Medical & Surgical Knowledge Translation Research Group, Boehringer Ingelheim/Eli Lilly (BI-LILLY joint venture), Eli Lily & Co, Insulet Corp, Medtronic, Merck & Co Inc, Novo Nordisk, Sanofi-Aventis. Funded grants, research or clinical trials: Eli Lilly, Novo Nordisk, Sanofi.

Exercising with diabetes requires extra preparation, so how can healthcare providers best guide those living with type 1 diabetes in exercising safely to maintain a healthy lifestyle? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Mike C. Riddell, a Professor at York University’s School of Kinesiology and Health Science and Muscle Health Research Centre, and a Senior Scientist at the LMC Diabetes and Manna Research in Toronto. He is a leading authority on exercise and diabetes, having published numerous peer-reviewed articles, book chapters, international guidelines, and a patient guidebook on the effects of exercise and stress on diabetes and metabolism. This episode discusses the different types of exercises recommended and the practical considerations surrounding blood glucose monitoring, carbohydrate intake, and insulin dosing adjustments when staying active for those living with diabetes. Our experts also touch on some new and exciting clinical data recently presented at the ADA 2022 Scientific Sessions related to diabetes and exercise. They discuss key findings from the Type 1 Diabetes Exercise Initiative (T1DEXI) study, which assessed the effect of exercise type on time in range by comparing continuous glucose monitoring data on active vs. sedentary days, of which Dr. Riddell was a co-author. Our experts also discuss key takeaways from the ULTRAFLEXI-1 study, which compared second-generation basal insulin analogues glargine 300 U/mL (Gla-300) and degludec 100 U/mL (IDeg-100) flexibility around spontaneous exercise sessions in adults with type 1 diabetes. 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. Riddell: Direct financial relationship including receipt of honoraria: Dexcom, Novo Nordisk, Sanofi, Lilly Diabetes. Membership on advisory boards or speaker’s bureau: Zucara Therapeutics, Zealand Pharma, Indigo Diabetes. Funded grants, research or clinical trials: Insulet Canada, Dexcom, Verily, Glyconet, JAEB Center for Health Research, Natural Sciences and Engineering Research Council of Canada (NSERC), Zucara Therapeutics, Mitacs Canada. Other financial relationships/investments: investments (shares) in Supersapiens and Zucara Theraputics.

Do second-generation basal insulin analogues really offer any advantages over their first-generation counterparts? 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 an Associate Editor for the Canadian Journal of Diabetes. This episode focuses on second-generation basal insulin analogues, and the clinical benefits they confer compared to previous generations. Dr. Cheng discusses how the design of next-generation basal insulin analogues allow flatter and longer time-action profiles, which translate to less hypoglycemia for those using it. Given that fear of hypoglycemia is a significant barrier for both physicians and patients, choosing therapies that limit those episodes can be an important consideration. Our experts also touch on the topics of biosimilars, populations for which second-generation basal insulin analogues may be most appropriate, and how different basal insulins can offer more dosing flexibility. 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. 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.

Diabetes Canada updated their recommendations for the pharmacologic glycemic management of type 2 diabetes in adults in 2020, but how can clinicians interpret and implement these guidelines in their everyday practice? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Peter Lin, the Director of Primary Care Initiatives at the Canadian Heart Research Centre and a Family Physician based in Toronto. He has been heavily involved in physician education, serving as an Associate Editor for the Elsevier WebPortal – Practice Update Primary Care, and was a contributing author to the 2013 and 2018 Diabetes Canada Clinical Practice Guidelines on Cardiovascular Protection in People With Diabetes. This episode discusses how the newly updated recommendations by Diabetes Canada have shifted the focus of pharmacologic management of type 2 diabetes, to now include consideration of other clinically relevant outcomes such as cardiovascular and renal benefits. Our experts take a comprehensive, in-depth walkthrough of the treatment algorithms presented in these updated guidelines. They also discuss practical considerations when selecting an antihyperglycemic agent at various points throughout the type 2 diabetes patient journey: at diagnosis; when reviewing, adjusting, or advancing therapy; and when starting or advancing insulin. 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. Lin: Direct financial relationship including receipt of honoraria: Astrazeneca, BoehringerIngelheim, Bayer, Eli Lilly, Merck, Sanofi, Amgen, mdBriefCase, Canadian Heart Research Center, Bayer, Lincorp Medical Inc., CCRN, CoreCare, CHIEF, LMC Diabetes & Endocrinology Group, Diabetes Canada, Novo Nordisk, Humber River Hospital, Canadian Medical & Surgical Knowledge Translation Research Group, HLS, Medexus, Pri-med Canada, liV Agency, Meducomm, The Rounds, Peterborough Medical Society, the Peterborough Regional Health Centre Foundation and Peterborough Public Health, WebMD, Medscape, Moderna, LifeLabs, Acino. Membership on advisory boards or speaker’s bureau: Astrazeneca, Boehringer Ingelheim, Bayer, Eli Lilly, Merck, Sanofi, Amgen, mdBriefCase, Canadian Heart Research Center, Lincorp Medical Inc., CCRN, CoreCare, CHIEF, LMC Diabetes & Endocrinology Group, Diabetes Canada, Novo Nordisk, Humber River Hospital, Canadian Medical & Surgical Knowledge Translation Research Group, HLS, Medexus, Pri-medCanada, liV Agency, Meducomm, TheRounds, Peterborough Medical Society, the Peterborough Regional Health Centre Foundationand Peterborough Public Health, WebMD, Medscape, Moderna, LifeLabs, Acino.

How can healthcare providers best guide Muslims living with diabetes to safely observe fasting during Ramadan? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Ally Prebtani, a Professor of Medicine in the Department of Internal Medicine, Endocrinology & Metabolism at McMaster University. This episode discusses the month of Ramadan, where a significant number of Muslims fast from dawn until dusk. Observing the Ramadan fast is associated with challenges and risks for those in the Muslim community living with diabetes. Our experts discuss risk stratification and how healthcare providers can be proactive in preparing those who choose to fast. They discuss practical tips to help people with diabetes safely navigate fasting during this holy month and emphasize the importance of understanding each person – who they are they, what treatments they are on, and how their diabetes care can be individualized. 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. Prebtani: Direct financial relationship including receipt of honoraria: Eli Lilly, Astra Zeneca, BI, Abbott, Novo Nordisk, Sanofi. Funded grants, research or clinical trials: Hypertension Canada, Diabetes Canada.

How do we approach diabetes management during pregnancy? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Denice Feig, an Endocrinologist, diabetes researcher, and champion for women’s health. She is Head of the Diabetes in Pregnancy Program at Mount Sinai Hospital and an Associate Professor at the University of Toronto’s Department of Medicine. Dr. Feig’s work aims to improve the standard of care for pregnant women with pre-existing and gestational diabetes. This episode discusses the topics of glycemic targets throughout pregnancy, taking second-generation basal analogues during pregnancy, and the use of continuous glucose monitoring (CGM) to improve outcomes for pregnant women with diabetes. Our experts also discuss Dr. Feig’s research investigating whether the use of CGM in women with type 1 diabetes can improve glycemic control compared to standard capillary blood glucose monitoring. 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. Feig: Direct financial relationship including receipt of honoraria: Sanofi. Membership on advisory boards or speaker’s bureau: Novo Nordisc. Funded grants, research or clinical trials: CIHR, JDRF.

Living with a chronic disease can take a toll on one’s mental health, so how can healthcare providers best support those living with diabetes? Our host, Dr. Ronald Goldenberg, takes a deeper look into this topic with Dr. Michael Vallis, a Health Psychologist and Health Behaviour Change Consultant based in Halifax, and an Associate Professor in Family Medicine at Dalhousie University. He has authored chapters in the recent 2013 and 2018 Diabetes Canada Clinical Practice Guidelines on Diabetes and Mental Health. This episode discusses the common mental health issues associated with diabetes, with a particular focus on diabetes distress, psychological insulin resistance, and the fear of hypoglycemia. Our experts expand on the topics of what drives these challenges, how to recognize them in people living with diabetes, and the recent advances in diabetes management that allow individuals to overcome these barriers. They also discuss how to address these issues in a collaborative manner for more effective diabetes care and greater overall health outcomes. 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. Vallis: Membership on advisory boards or speaker’s bureau: Novo Nordisk, Abbvie, Bausch, Boehringer Ingelheim, Sanofi, Abbott, Lifescan, Merck. Funded grants, research or clinical trials: Novo Nordisk, Bausch, Abbott.

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. 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. 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.

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.

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. 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. 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.

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.