Trends in Treatment, Management of Diabetes for Pharmacists

Pharmacy Times spoke with Susan Cornell, PharmD, Associate Director, OEE at Midwestern University College of Pharmacy, about her session at McKesson ideaShare 2022, titled "Diabetes Updates, Guidelines, and Trends."

Cornell: It changed this year and I'm very pleased with it. I've been predicting that Metformin would no longer be first line therapy for the past probably 5 to 6 years. You know, and finally, I can say Metformin is no longer considered our only choice for first line therapy to treat diabetes. And today, we have so many better options. You know, going back to what I said earlier, where we just can't look at just sugar, we have to look beyond sugar, cardiovascular, renal, liver weight, hypoglycemic risk. So these are things we have to look at. And unfortunately, Metformin doesn't hit those targets. You know, Metformin is great at lowering sugar, fasting sugar, but that's it. And, you know, again, good drug, it was the best thing in its day; but like me, it's getting older, and you know, maybe it's time for Metformin to retire at this point. So one of the things we have to look at is, what therapies do we have now that are approved and can be used first line? And of course, based on the new guidelines, we know that SGLT-2 inhibitors, as well as the injectable GLP-1 agonist can actually be an alternative, primarily looking at the ones that have a label indication for cardiovascular benefit. So I think that's important to note. So it's not all SGLT-2s, it's not all GLP-1 agonists, it's the ones that have a labeling for cardiovascular heart failure, or kidney disease benefit. And those are where we're looking to see potentially first line therapy. And I believe a trend that pharmacists are going to see, and they should be very anxious to see this, and maybe even recommend this to patients, is the combination therapy of an SGLT-2 inhibitor with a GLP-1 agonist. So again, that combination is really, what I see is, the future trend in managing diabetes, because you just get much better…not only glycemic coverage, but cardiovascular, renal liver and weight reduction coverage from those drugs. So you combine the two together and in a way you're setting the patient up for success.