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CDE Diabetes

Study Guide: Diabetes and Transplantation (Chapter 20)

1. Overview & Rationale

Diabetes is a bidirectional issue in transplantation: it is the leading cause of kidney failure requiring transplant, and transplantation (and its associated medications) can cause new-onset diabetes.

  • Kidney Transplant: For people with diabetes and End Stage Renal Disease (ESRD), kidney transplantation provides better long-term outcomes than dialysis.
  • Beta-Cell Replacement: Whole pancreas or islet transplantation can restore endogenous insulin, stabilizing glucose and preventing severe hypoglycemia in Type 1 Diabetes.
  • Post-Transplant Diabetes Mellitus (PTDM): A common complication after solid organ transplant, associated with reduced graft survival and increased mortality.

2. Transplantation Options for Type 1 Diabetes

A. Pancreas Transplantation

This involves major abdominal surgery but offers the highest chance of long-term insulin independence.

  • Simultaneous Pancreas-Kidney (SPK):
    • Indication: Type 1 Diabetes + ESRD.
    • Benefit: Improves kidney graft survival compared to kidney transplant alone. It prolongs insulin independence and patient survival.
    • Success: Median graft survival is ~9 years.
  • Pancreas After Kidney (PAK): For those who already have a functioning kidney transplant.
  • Pancreas Transplant Alone (PTA): Rare; for those with severe metabolic complications but preserved kidney function.

B. Islet Transplantation

A minimally invasive procedure where islets are infused into the liver via the portal vein.

  • Islet Allotransplantation (Donor Islets):
    • Goal: Primarily to prevent severe hypoglycemia and restore hypoglycemia awareness, even if total insulin independence isn’t achieved.
    • Outcome: 5-year insulin independence rates have improved to ~60%.
  • Islet Autotransplantation (Self Islets):
    • Indication: People undergoing total/partial pancreatectomy for benign disease (e.g., chronic pancreatitis).
    • Benefit: Prevents surgical diabetes; does not require immunosuppression because the cells are the patient’s own.

 

3. Comparison: Islet vs. Pancreas Transplant (Table 2)

This comparison is high-yield for the exam.

FeatureIslet
Transplant		Pancreas
Transplant
InvasivenessMinimally invasive (infusion)Major abdominal surgery
Insulin IndependenceVariable; may require multiple infusionsHigh rate; more durable
Primary GoalEliminate severe hypoglycemiaInsulin independence & Renal protection (SPK)
ImmunosuppressionRequired (Life-long)Required (Life-long)
SteroidsGenerally AvoidedMay be used

4. Post-Transplant Diabetes Mellitus (PTDM)

Formerly known as “New Onset Diabetes After Transplantation” (NODAT).

Risk Factors:

  • General: Age, obesity, family history, metabolic syndrome.
  • Transplant-Specific: Hepatitis C, Cytomegalovirus (CMV), Corticosteroids, Calcineurin inhibitors (immunosuppressants).

Screening & Diagnosis:

  • Early Period (0–3 months):
    • Hyperglycemia is common due to high-dose steroids and stress.
    • Screening: Monitor post-lunch (4 pm) capillary blood glucose.
    • A1C: NOT reliable in the first 3 months due to surgical blood loss/transfusions/turnover.
  • Stable Period (>3 months):
    • A1C 6.5% can be used for diagnosis once the patient is stable.
    • OGTT: The standard 2-hour Oral Glucose Tolerance Test is the most sensitive but often impractical. Fasting Plasma Glucose (FPG) is the least sensitive.

Management of PTDM:

  • Insulin: Preferred agent in the acute hospital setting or during high-dose steroid therapy.
  • Metformin: First-line oral agent if renal function is stable.
  • Secretagogues (Sulfonylureas/Meglitinides): AVOID in patients with renal impairment or pancreas transplant dysfunction to preserve beta-cell mass and avoid hypoglycemia.
  • SGLT2 Inhibitors: Use with caution due to infection risk in immunosuppressed patients.

Diabetes CanadaClinical Practice Guidelines Recommendations

Key takeaways from the “Recommendations” section (Page 5147).

  1. SPK Selection: Individuals with Type 1 diabetes and ESRD should be considered for Simultaneous Pancreas-Kidney (SPK) transplantation [Grade C, Level 3].
  2. Islet Consideration: Islet allotransplantation may be considered for T1D with marked glycemic lability or severe hypoglycemia despite optimal care [Grade C, Level 3].
  3. PTDM Screening:
    • Screen for PTDM with A1C at 3 months, 12 months, and annually [Grade C, Level 3].
    • Use OGTT or post-lunch monitoring in the first 3 months (when A1C is unreliable) [Grade C, Level 3].
  4. PTDM Management:
    • Treat to individualized targets.
    • Avoid insulin secretagogues if renal impairment is present [Grade D, Consensus].
    • Use insulin for metabolic decompensation [Grade D, Consensus].

Reference:

Senior PA, AlMehthel M, Miller A, Paty BW. Diabetes and Transplantation. Canadian Journal of Diabetes. 2018;42:S145-S149. doi:10.1016/j.jcjd.2017.10.017
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CDE Diabetes

Flashcards: Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations (Chapter 19 & Updates)

Vaccination is a cornerstone of preventative care for people with diabetes, who face higher risks of infection-related morbidity. These flashcards integrate the foundational knowledge from Chapter 19 with the critical updates from the 2024/2025 Immunization Tool, helping you navigate the shift toward newer conjugate vaccines and expanded protection.

Key Topics Covered:

  • Pneumococcal Update: Memorizing the new standard: a single dose of Pneu-C-21 or Pneu-C-20 for adults, regardless of prior vaccination history with Pneu-C-13 or Pneu-P-23.
  • Herpes Zoster (Shingles): Understanding the recommendation for the Recombinant Zoster Vaccine (RZV) and the required 1-year wait period for those who previously received the live vaccine or had an episode of shingles.
  • Influenza: Reinforcing the need for annual vaccination to reduce hospitalization risk by ~40% and all-cause mortality.
  • Hepatitis B: Identifying adults with diabetes as a high-risk group (due to assisted blood glucose monitoring) requiring catch-up immunization.
  • Emerging Vaccines: Reviewing the individualized recommendations for Respiratory Syncytial Virus (RSV) and updated COVID-19 boosters.
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CDE Diabetes

Practice Exam: Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations (Chapter 19 & Updates)

People with diabetes are at a significantly higher risk for morbidity and mortality from vaccine-preventable diseases compared to the general population. The Clinical Practice Guidelines emphasize that vaccination is a critical, yet often overlooked, component of comprehensive diabetes care.

This practice exam tests your ability to apply the 2018 Guidelines and the most recent 2024/2025 Immunization Tool recommendations, covering routine schedules and specific indications for high-risk adults.

Key Concepts Covered in This Exam:

  • Influenza: Understanding the recommendation for annual vaccination to reduce hospitalization rates (by approx. 40%) and death during flu season.
  • Pneumococcal Updates: Mastering the updated protocols which now recommend one dose of Pneu-C-21 or Pneu-C-20 for adults, regardless of their previous vaccination status with Pneu-C-13 or Pneu-P-23.
  • Hepatitis B: Recognizing that adults with diabetes are at higher risk of Hepatitis B infection (e.g., from assisted blood glucose monitoring) and should be immunized if not vaccinated in childhood.
  • Herpes Zoster (Shingles): Identifying the recommendation for the Recombinant Zoster Vaccine (RZV) for adults 50 years, including those who have previously received the live vaccine.
  • Emerging Vaccines: Reviewing new guidance for COVID-19 boosters and the individualized recommendation for Respiratory Syncytial Virus (RSV) vaccination in high-risk populations, including those with diabetes.

1. What percentage of Canadians are expected to develop herpes zoster at some point in their lives?

2. In a Canadian cohort study, which of the following was observed in working-age adults with diabetes regarding influenza?

3. In the Dutch case-control study, influenza vaccination reduced hospitalization rates for which of the following conditions by 70%?

4. The natural process of aging predisposes older people to herpes zoster through which mechanism?

5. In a Dutch case-control study, how much higher was the incidence of complications in unvaccinated individuals compared to those vaccinated against influenza?

6. Adults with diabetes between ages 23 to 59 years are at approximately what increased risk of acute hepatitis B compared to adults without diabetes?

7. Influenza vaccination is associated with approximately what percentage reduction in mortality for high-risk individuals?

8. How often should people with diabetes receive influenza vaccination?

9. The herpes zoster (shingles) rash results from reactivation of latent virus in which anatomical location?

10. Hepatitis B outbreaks in long-term care facilities have been linked to which of the following practices in people with diabetes?

11. What proportion of herpes zoster cases occur in adults 50 years of age and older?

12. Evidence from studies has demonstrated that diabetes mellitus is often accompanied by which immune system abnormality?

13. The major risk factor for development of herpes zoster is:

14. What is the leading cause of hepatocellular carcinoma (HCC) worldwide?

15. Which of the following is NOT mentioned as a condition associated with increased risk of herpes zoster according to the guidelines?

16. Which types of diabetes are associated with higher risk of hepatitis B virus (HBV) infection?

17. The primary infection syndrome of varicella-zoster virus presents as which condition?

18. What is the most common complication of herpes zoster that persists after lesions have healed?


 

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CDE Diabetes

Study Guide: Immunization in Diabetes (Updated 2025)

1. Overview & Principles

People with diabetes are at higher risk for complications from vaccine-preventable diseases. The new 2025 guidance emphasizes a broader range of vaccines and simplified protocols for pneumococcal protection.

  • Advocacy: Clinicians should discuss ALL age-appropriate vaccines regardless of public/private coverage.
  • Timing: Routine childhood immunizations should be up to date (refer to provincial schedules).
  • Timing: Routine childhood immunizations should be up to date (refer to provincial schedules).

2. Routine & Annual Vaccinations

These are “Ongoing Immunizations” recommended for adults with diabetes.

  • COVID-19:
    • Frequency: Annual.
    • High-Risk: Some high-risk individuals may require 2 doses/year.
    • Timing: Minimum 3 months from the last dose or 3 months post-infection.
  • Influenza (Flu Shot):
    • Frequency: Annual.
    • Target: All adults with diabetes.
  • Tetanus-Diphtheria-Pertussis (Tdap):
    • Frequency: Booster every 10 years.

3. One-Time / Series Vaccinations (Major Updates)

The protocols for Pneumococcal and Shingles have been significantly updated from the 2018 guidelines.

A. Invasive Pneumococcal Disease

  • New Recommendation: One dose of Pneu-C-21 OR Pneu-C-20.
  • History: This single dose is recommended regardless of previous vaccination status with Pneu-C-13 (Prevnar-13) or Pneu-P-23 (Pneumovax-23).
  • Age: Recommended for adults age 18+.

B. Herpes Zoster (Shingles)

  • Vaccine Type: Recombinant Zoster Vaccine (RZV) is recommended.
  • Age: Recommended for adults age 50 years.
  • Previous History:
    • If the patient had a previous episode of Shingles: Wait at least 1 year before vaccinating.
    • If the patient received the live vaccine (LZV) previously: Wait at least 1 year before vaccinating with RZV.

C. Respiratory Syncytial Virus (RSV)

  • Strategy: Individualized assessment.
  • Risk Factors: High-risk populations include diabetes, chronic kidney disease (CKD), and obesity.
  • Age: The tool highlights consideration starting at age 60. (Note: Recent NACI guidance also discusses ages 50-59 ).

D. Hepatitis B

  • Indication: Recommended if not vaccinated in childhood or if medical conditions change.
  • Specific Risk: Chronic Kidney Disease (CKD) with or without dialysis.
  • Vaccine: Most people should be immunized with the combined Hepatitis A + B vaccine.

4. Additional Lifetime Recommendations

These are not specific only to diabetes but are part of comprehensive care.

  • Human Papillomavirus (HPV): Recommended if not previously vaccinated with a complete series (up to age ~44 in chart).
  • Meningococcal-ACYW: Booster at 12–24 years old (even if vaccinated as an infant).
  • Measles-Mumps-Rubella (MMR): Adults born in or after 1970 should receive one dose.

References:

Husein N, Chetty A. Influenza, Pneumococcal, Hepatitis B and Herpes Zoster Vaccinations. Canadian Journal of Diabetes. 2018;42:S142-S144. doi:10.1016/j.jcjd.2017.10.016
 
Diabetes Canada. Immunizations Recommended for Adults Living with Diabetes. Accessed August 23, 2025. https://guidelines.diabetes.ca/getmedia/5365a51d-a34b-4176-bb1f-beed55239ebb/Immunization-Tool_Ver_3.pdf
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CDE Diabetes

Flashcards: Diabetes and Mental Health (Chapter 18 Update)

The 2023 Guidelines emphasize that mental health is not secondary to physical health in diabetes care; the two have a bidirectional relationship that significantly impacts outcomes. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the diagnostic distinctions, screening tools, and management strategies for the psychosocial challenges faced by people living with diabetes.

Key Topics Covered:

  • Diabetes Distress vs. Depression: Understanding the difference between the emotional burden of diabetes management (distress) and clinical depression, and why this distinction matters for treatment.

  • Screening Protocols: Memorizing the recommendation to routinely screen for diabetes distress, anxiety, and depressive symptoms using validated tools.

  • Eating Disorders: Identifying “diabulimia” (insulin omission for weight loss) in Type 1 diabetes and recognizing Binge Eating Disorder in Type 2 diabetes.

  • Serious Mental Illness: Reviewing the metabolic risks associated with schizophrenia and bipolar disorder, specifically the impact of antipsychotic medications on weight and insulin sensitivity.

  • Interventions: Recalling evidence-based psychosocial interventions like Cognitive Behavioural Therapy (CBT) and their role in improving quality of life.

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CDE Diabetes

Practice Exam: Diabetes and Mental Health (Chapter 18 Update)

Mental health is integral to diabetes care. The 2023 Guidelines highlight the bidirectional relationship between diabetes and psychiatric disorders, emphasizing that psychological well-being is a critical predictor of successful self-management and metabolic outcomes.

This practice exam tests your ability to identify, screen for, and manage the psychosocial challenges commonly faced by individuals living with diabetes, ranging from diagnosis-related distress to severe mental illness.

Key Concepts Covered in This Exam:

  • Diabetes Distress vs. Depression: Distinguishing between the emotional burden of living with diabetes (distress) and Major Depressive Disorder, and knowing when to refer for specialized care.

  • Screening Protocols: Understanding the recommendation to routinely screen for diabetes distress, anxiety disorders, and depressive symptoms using validated tools.

  • Eating Disorders: Recognizing “diabulimia” (insulin omission for weight loss) in Type 1 diabetes and Binge Eating Disorder in Type 2 diabetes as critical barriers to glycemic control.

  • Serious Mental Illness: Managing the metabolic risks associated with schizophrenia and bipolar disorder, including the impact of antipsychotic medications on weight and insulin resistance.

  • Psychosocial Interventions: Identifying evidence-based interventions such as Cognitive Behavioural Therapy (CBT) and motivational interviewing to improve adherence and quality of life.

Please go to Practice Exam: Diabetes and Mental Health (Chapter 18 Update) to view this quiz

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CDE Diabetes

Study Guide: Diabetes and Mental Health (2023 Update)

1. Overview

The relationship between diabetes and mental health is bidirectional. Having diabetes increases the risk of psychiatric disorders, and psychiatric disorders increase the risk of developing diabetes (and complicating its management).

  • Prevalence: Mental health disorders are more common in people with diabetes than the general population.

  • Impact: Co-occurring mental health issues lead to:

    • Decreased self-care participation.

    • Reduced quality of life.

    • Increased risk of diabetes complications.

    • Increased healthcare costs.

    • Earlier all-cause mortality (specifically for depression).

2. Screening Recommendations (The "30-Second" Rule)

The guidelines emphasize regular screening using validated tools. You don’t need to be a psychiatrist to screen; it is a core CDE competency.

ConditionFrequencyScreening
Tool
Examples		Notes
Diabetes DistressRoutine / Regular

DDS
 (Diabetes Distress Scale)


PAID
 (Problem Areas in Diabetes)

Distress is distinct from depression. It relates specifically to the burden of diabetes management.
DepressionRoutine / Regular

PHQ-9
 (Patient Health Questionnaire)


HADS
(Hospital Anxiety and Depression Scale)

Depression affects ~30% of people with diabetes (10% major depression).
Anxiety DisordersRoutine / RegularGAD-7
 (Generalized Anxiety Disorder-7)		Generalized Anxiety Disorder affects ~14% of people with diabetes.
Eating DisordersAs clinically indicatedDEPS-R
 (Diabetes Eating Problem Survey-Revised)		Especially “Diabulimia” (insulin restriction to lose weight) in T1D.

 

3. Key Conditions & Associations

A. Diabetes Distress

  • Definition: An emotional response to the burden of living with and managing diabetes (e.g., “burnout,” feeling overwhelmed). It is not a psychiatric disorder but can lead to one if untreated.

  • Management: Education, support, and validating feelings often help. It does not necessarily require medication; it requires diabetes-specific support.

B. Depression

  • Link: Bi-directional.

  • Treatment:

    • Psychotherapy (CBT is gold standard).

    • Pharmacotherapy (SSRIs/SNRIs). Note: Treatment improves mood but does not consistently improve A1C unless self-care behaviors also change.

C. Schizophrenia & Bipolar Disorder

  • Risk: People with these conditions have a higher risk of developing Type 2 diabetes.

  • Medication Impact: Second-generation (atypical) antipsychotics (e.g., olanzapine, clozapine, quetiapine) are associated with significant metabolic side effects (weight gain, dyslipidemia, hyperglycemia).

  • Recommendation: Mandatory metabolic monitoring (weight, waist circumference, BP, FPG/A1C, lipids) for anyone on atypical antipsychotics.

D. Eating Disorders

  • Insulin Omission: In Type 1 diabetes, restricting insulin to cause glycosuria and weight loss is a dangerous purging behavior (often called “Diabulimia”).

  • Screening: Look for unexplained A1C elevation, recurrent DKA, or weight loss despite reported good intake.

4. Psychosocial Treatment Approaches

The guidelines recommend integrating psychosocial care into routine diabetes practice.

  • Motivational Interviewing (MI): A person-centered approach to strengthen motivation for change.

  • Cognitive Behavioral Therapy (CBT): Effective for depression and anxiety in diabetes.

  • Coping Skills Training: Helps patients manage stress and the mental load of diabetes.

  • Family Therapy: Particularly useful for children/adolescents to address family conflict regarding management.

5. Diabetes Canada Clinical Practice Guidelines Recommendations

  • Screening: All individuals with diabetes should be regularly screened for diabetes distress and symptoms of common psychiatric disorders (depression, anxiety) [Grade D, Consensus].

  • Psychosocial Interventions: Incorporate interventions like CBT, motivational interviewing, and coping skills training into care to improve outcomes [Grade B, Level 2].

  • Severe Mental Illness: Individuals with severe mental illness (schizophrenia, bipolar) require frequent screening for diabetes and metabolic risk factors, especially if prescribed atypical antipsychotics [Grade D, Consensus].

  • Youth: Adolescents with Type 1 diabetes should be screened for eating disorders (insulin omission) when there is unexplained hyperglycemia or weight loss [Grade D, Consensus].

Reference:

Robinson DJ, Hanson K, Jain AB, et al. Diabetes and Mental Health – 2023. Canadian Journal of Diabetes. 2023;47(4):308-344. doi:10.1016/j.jcjd.2023.04.009
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CDE Diabetes

Flashcards: Weight Management in Diabetes (Chapter 17)

Weight management is a primary therapeutic goal in the 2018 Clinical Practice Guidelines, as obesity is a major driver of type 2 diabetes and its complications. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the evidence-based strategies for assessment, behavioural intervention, pharmacotherapy, and surgery to support patients in achieving healthier weights.

Key Topics Covered:

  • Therapeutic Targets: Memorizing the impact of sustained weight loss (5% of initial body weight) on glycemic control and cardiovascular risk factors.

  • Intervention Hierarchy: Reviewing the tiered approach that begins with healthy behavior interventions as the foundation for all treatment plans.

  • Pharmacotherapy: Identifying specific weight management medications approved for use in Canada and their mechanisms of action.

  • Surgical Options: Understanding the indications for bariatric surgery and its role in potentially inducing diabetes remission.

  • Medication Selection: Recalling which antihyperglycemic agents promote weight loss or are weight-neutral versus those associated with weight gain.

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CDE Diabetes

Practice Exam: Weight Management in Diabetes (Chapter 17)

Obesity is a significant risk factor for the development of type 2 diabetes and complications in both type 1 and type 2 diabetes. The 2018 Clinical Practice Guidelines emphasize that weight management is not merely an aesthetic goal but a primary therapeutic target to improve glycemic control and cardiovascular health.

This practice exam tests your ability to apply the evidence-based recommendations for behavioural, pharmacological, and surgical weight management interventions.

Key Concepts Covered in This Exam:

  • Therapeutic Targets: Understanding that a sustained weight loss of 5% of initial body weight can significantly improve glycemic control and cardiovascular risk factors.

  • Intervention Hierarchy: Recognizing healthy behaviour interventions as the cornerstone of treatment, to be maintained even when medications or surgery are added.

  • Pharmacotherapy: Identifying the role of specific weight management medications for individuals with diabetes and obesity to improve metabolic control.

  • Surgical Options: Knowing the indications for bariatric surgery and its potential to induce diabetes remission or significant improvement.

  • Medication Selection: Applying the principle that the effect on body weight must be considered when selecting antihyperglycemic agents, prioritizing those with weight-loss or weight-neutral properties.

Please go to Practice Exam: Weight Management in Diabetes (Chapter 17) to view this quiz

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CDE Diabetes

Study Guide: Weight Management in Diabetes (Chapter 17)

1. Overview & Pathophysiology

Obesity is a major driver of Type 2 diabetes and complicates its management.

  • Prevalence: 80-90% of people with Type 2 diabetes have overweight or obesity. Rates are also rising in Type 1 diabetes (sevenfold increase in 20 years).
  • Benefits of Weight Loss: A modest weight loss of 5–10% of initial body weight can improve insulin sensitivity, glycemic control, and blood pressure.
  • Greater weight loss may be required to improve Obstructive Sleep Apnea (OSA) and dyslipidemia.
  • Sustained weight loss can be achieved through healthy behavior interventions, medications, or bariatric surgery.

2. Assessment of Overweight and Obesity

Assessment should go beyond just BMI to include distribution of adiposity and contributing factors.

  • Clinical Measurements:
    • Height, weight, BMI, and Waist Circumference (WC).
    • WC Risk Thresholds: cm (Men), cm (Women) indicate increased health risk.
    • Note: Ethnic-specific cut-offs exist (e.g., lower thresholds for South Asian/Chinese populations: cm for men, cm for women).
  • Contributing Factors:
    • Medications (antipsychotics, antidepressants, some antihyperglycemics).
    • Psychological factors (emotional eating, depression, ADHD).
    • Physical barriers (osteoarthritis, dyspnea).

3. Treatment Strategies

A. Healthy Behaviour Interventions

  • Cornerstone: Combined dietary modification, physical activity, and behavior therapy is most effective.
  • Structure: Interprofessional and group programs show better results than solo interventions.
  • Diet: Moderate carbohydrate reduction has shown benefits in lipids and glycemic stability.
  • Goals: Reasonable weight loss goals are 1–2 kg/month (requires ~500 kcal/day deficit).

B. Pharmacotherapy for Diabetes (Weight Considerations)

The choice of diabetes medication profoundly impacts weight.

  • Weight Gain: Insulin, Insulin Secretagogues (Sulfonylureas, Meglitinides), Thiazolidinediones (TZDs).
  • Weight Neutral: Metformin, DPP-4 Inhibitors, Acarbose.
  • Weight Loss:
    • GLP-1 Receptor Agonists: ~3 kg loss.
    • SGLT2 Inhibitors: 2–3 kg loss.

NOTE: This chapter was written in 2018 prior to the launch of semaglutide and tirzepatide.  For more up to date information please visit: Obesity Canada’s Pharmacotherapy Guideline chapter

D. Bariatric Surgery

  • Indications: Considered for Type 2 diabetes with BMI OR BMI with comorbidities (like diabetes) when other methods fail.
  • Benefits: Can lead to remission of Type 2 diabetes.
  • Procedures:
    • Roux-en-Y Gastric Bypass (RYGB): High remission rates.
    • Sleeve Gastrectomy: Effective; removes ghrelin-rich fundus.
    • Gastric Banding: Largely abandoned due to complications and lower efficacy.
  • Predictors of Remission: Higher C-peptide (good beta-cell reserve), younger age, shorter diabetes duration, no insulin use pre-op.

4. 2018 Clinical Practice Guidelines Recommendations

  1. Program: Interprofessional weight management programs are recommended for those with/at risk of diabetes to improve CV risk [Grade A, Level 1A].
  2. Medications: Weight management medications (Liraglutide 3.0 mg or Orlistat) may be considered to promote weight loss and improve glycemic control [Grade A, Level 1A].
  3. Choice of Agent: When selecting antihyperglycemic agents for adults with Type 2 diabetes and obesity, the effect on body weight should be considered [Grade D, Consensus].
  4. Surgery: Bariatric surgery may be considered for adults with Type 2 diabetes and BMI

Reference:

Wharton S, Pedersen SD, Lau DCW, Sharma AM. Weight Management in Diabetes. Canadian Journal of Diabetes. 2018;42:S124-S129. doi:10.1016/j.jcjd.2017.10.015