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Guideline Recommendations

  • NICE suggests that treatment with SGLT2 inhibitors, such as Invokana, may be appropriate for some adults with type 2 diabetes if metformin is contraindicated or not tolerated. 1
  • NICE also suggests SGLT2 inhibitors, such as Invokana, as an option for dual therapy (i.e. at first intensification) for patients whose HbA1c rises to 58mmol/mol (7.5%). 1
  • An SGLT2 inhibitor, such as Invokana, can also be considered at second intensification as an add-on to other agents including metformin, sulphonylureas, thiazolidinediones, DPP4 inhibitors, GLP-1 agonists and insulin. 1
  • The Scottish Intercollegiate Guidelines Network (SIGN) recommends SGLT2 inhibitors such as Invokana as add-on therapy to metformin, in addition to lifestyle measures, for patients with type 2 diabetes who do not achieve an HbA1c of <53mmol/mol (7.2%) or individual target as agreed. 2
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Early Intervention

Benefits of early intervention

  • Achieving adequate glycaemic control in the early years following diagnosis has been shown to significantly reduce the risk of complications later in the course of the disease. 3
  • Invokana has been shown in clinical trials to deliver consistent reductions in HbA1c at both 100mg and 300mg doses. 4-9
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Early Intensification

Benefits of reducing the glycaemic legacy

  • Time spent in a hyperglycaemic state is known as the glycaemic legacy. 3

  • Even short periods of hyperglycaemia are known to increase the risk of microvascular and macrovascular complications. 10
  • NICE recommends intensifying therapy when glycaemic control is inadequate (HbA1c of >58mmol/mol [>7.5%]) with metformin (or alternative agent if metformin is contraindicated or not tolerated) and lifestyle measures. 1
  • Earlier intensification when HbA1c rises to between 53 and 58mmol/mol (7 – 7.5%) reduces the risks associated with extended periods of poor glycaemic control. 11

Earlier and appropriate intervention may improve patients’ chances of reaching their goals

Earlier and appropriate intervention may improve patients’ chances of reaching their goals - Invokana (canagliflozin) Chart

Stepwise versus early aggressive intensification of therapy in type 2 diabetes. Adapted from Khunti K, et al. Diabetes Care 2013;36:3411-7
and Del Prato S, et al. Int J Clin Pract 2005;59:1345-55.

Downey J. The importance of achieving target HbA1c in the early years. Practice Nurse 2018;48(1):12–16.
Click here to read the full article
References
  1. Reference 5(8)
  2. Reference 6(9)
  3. Chalmers J, Cooper M. UKPDS and the legacy effect. N Engl J Med 2008;359:1618–20
  4. Lavalle-Gonzalez FJ et al. Diabetologia 2013;56(12):2582-92
  5. Stenlōf K et al. Diabetes Obes Metab 2013;15(4):372-82
  6. Forst T et al. Diabetes Obes Metab 2014;16:467-77
  7. Cefalu WT et al. The Lancet 2013;382(9896):941-50
  8. Schernthaner G et al. Diabetes Care 2013;36(9):2508-15
  9. Wilding JPH et al. J Clin Pract 2013:67(12):1267-82
  10. Epidemiology of Diabetes Interventions and Complications (EDIC) Study Group. JAMA 2003;290(16):2159-67
  11. Khunti K et al. Diabetes Obes Metab 2018;20:389-399