Diving Into Diabetes 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.
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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. Ratzki-LeeWing
Direct financial relationship including receipt of honoraria: Eli Lilly, Novo Nordisk, American Diabetes Association. Funded grants, research, or clinical trials: Sanofi Global.Dr. Harris:
Direct financial relationship including receipt of honoraria or in-kind compensation: Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly, HLS Therapeutics, Janssen, Novo Nordisk, Sanofi Aventis. Membership on advisory boards: Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly, HLS Therapeutics, Janssen, Novo Nordisk, Sanofi Aventis. Funded grants, research, or clinical trials: Abbott, Applied Therapeutics Inc., AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, Sanofi Aventis.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.
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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. Gerstein
Membership on advisory board or speakers’ bureaus: Sanofi, Lilly, Merck, AstraZeneca, DKSH, Zuellig, Novo Nordisk, Abbott, Pfizer, Kowa, Hanmi, Carbon Brand, Jiangsu Hanson Pharma. Funded grants, research, or clinical trials: Eli Lilly, Merck, AstraZeneca, Novo NordiskDr. Dasgupta:
Funded grants, research, or clinical trials: CIHR, The Lawson Foundation, The JR McConnell Foundation.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.
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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. Ronald 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 speakers’ bureaus: 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. Bruce Perkins:
Direct financial relationship including receipt of honoraria: Novo Nordisk, Sanofi, Abbott, Insulet, Medtronic. Membership on advisory boards: Abbott, Insulet, Novo Nordisk, Sanofi, Vertex. Funded grants, research, or clinical trials: Bank of Montreal, Novo Nordisk. Patent on a drug, product, or device: Boehringer Ingelheim.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.
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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. Ronald 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 speakers’ bureaus: 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. Ilana Halperin:
Direct financial relationship including receipt of honoraria or in-kind compensation: Abbott, Dexcom, Novo Nordisk, Sanofi. Membership on advisory boards: Dexcom, Sanofi.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
Direct financial relationship including receipt of honoraria: Eli Lilly, Novo Nordisk, American Diabetes Association. Funded grants, research, or clinical trials: Sanofi Global.Dr. Harris:
Direct financial relationship including receipt of honoraria or in-kind compensation: Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly, HLS Therapeutics, Janssen, Novo Nordisk, Sanofi Aventis. Membership on advisory boards: Abbott, AstraZeneca, Bayer Inc., Dexcom, Eli Lilly, HLS Therapeutics, Janssen, Novo Nordisk, Sanofi Aventis. Funded grants, research, or clinical trials: Abbott, Applied Therapeutics Inc., AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, Sanofi Aventis.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.