Module 5: Antihyperglycemic agents

This module will cover the use of oral antihyperglycemic agents currently available in Canada. Most people with type 2 diabetes will eventually need medication to help them keep blood glucose levels in the recommended range despite doing the best they can with lifestyle choices. For health care providers, the main question is when to start medication. First there is discussion with the person to help determine if further lifestyle changes may yield any improvement. When medication is indicated, the next step is to determine which medication and how to titrate the dose.

There is no simple answer to these questions because everyone is different and treatment must be individualized. In this module review the factors that go into making these decisions and what you can do to help people adhere to the recommended medication regimen.

Objectives

You have completed this module when you are able to:

  1. Explain the meaning of, "Type 2 diabetes is a progressive disease";
  2. Explain how to determine when antihyperglycemic agents should be started in type 2 diabetes;
  3. State the first-line agent recommended by the Canadian Diabetes Association (CDA);
  4. Explain why this agent is suggested as first-line;
  5. Explain the benefits of using a combination of classes of antihyperglycemic agents to manage diabetes;
  6. Explain the action of each class of antihyperglycemic agents used for diabetes management;
  7. Describe the most common side effects of antihyperglycemic agents;
  8. State the contraindications of each class of antihyperglycemic agents;
  9. Explain on what basis the decision is made to start insulin;
  10. Explain the benefit of basal insulin added to antihyperglycemic agents;
  11. Explain how basal insulin can be titrated to achieve target blood glucose levels; and
  12. Explain the sign that indicates that basal insulin alone is not sufficient.

To enhance your learning, you may also wish to refer to the "Pharmacologic management of type 2 diabetes" section of the Canadian Pharmacists Journal's supplement on Diabetes. (CPJ 2009;142[SUPPL 1])