What is the most appropriate initial pharmacological treatment?
Anonymous Quiz
0%
A. Insulin glargine
75%
B. Metformin
18%
C. Glimepiride
4%
D. Pioglitazone
4%
E. Sitagliptin
A 62-year-old man with T2DM presents for routine follow-up. He has been taking metformin 1 g twice daily for 8 months. His HbA1c is 9.4%. He has a BMI of 34 kg/m², eGFR of 78 mL/min/1.73 m², and a previous myocardial infarction 2 years ago. He has no symptoms of hyperglycaemia.
Which of the following is the most appropriate next step in management?
A. Add glibenclamide
B. Start basal insulin immediately
C. Add a GLP-1 receptor agonist with cardiovascular benefit
D. Add pioglitazone
E. Continue metformin alone and repeat HbA1c after 12 months
Which of the following is the most appropriate next step in management?
A. Add glibenclamide
B. Start basal insulin immediately
C. Add a GLP-1 receptor agonist with cardiovascular benefit
D. Add pioglitazone
E. Continue metformin alone and repeat HbA1c after 12 months
MEDICINEnotes
What is the most appropriate initial pharmacological treatment?
Metformin first choice to treatment type 2 DM
#Metformin
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.
First-line treatment.
1. Rule out renal failure (RF) before starting Metformin.
2. Reassess HbA1c after 3 months.
If HbA1c is greater than 58 mmol/mol (7.5%), add a second drug.
#Dual_therapy
اختار واحد من الاثنين اهما
Metformin + Gliptin.
Metformin + Sulfonylurea.
Metformin + Pioglitazone.
Metformin + SGLT-2 inhibitor.
Reassess HbA1c after 3 months.
If HbA1c remains greater than 58 mmol/mol (7.5%), proceed to Triple therapy.
#Triple_therapy
اختار واحد من الثلاثة اهما
Metformin + Gliptin + Sulfonylurea.
Metformin + Pioglitazone + Sulfonylurea.Metformin + Sulfonylurea + SGLT-2 inhibitor.
Metformin + Pioglitazone + SGLT-2 inhibitor.
If HbA1c remains above 7.5% despite triple therapy → Insulin therapy.
لو كانت Triple therapy:
Not effective.
Not tolerated.
Contraindicated.
AND BMI greater than 35.
نستخدموا:
Metformin + Sulfonylurea + GLP-1 mimetic.
لو الـ Patients من البداية مايتحملش
Metformin is not tolerated or contraindicated (CI)
Initial monotherapy
اختار واحد:
Gliptin.
Sulfonylurea.
Pioglitazone.
Dual therapy
إذا HbA1c أكبر من (7.5%):
Gliptin + Pioglitazone.
Gliptin + Sulfonylurea.
Pioglitazone + Sulfonylurea.
Insulin
If HbA1c remains greater than 58 mmol/mol (7.5%)
نتنقلوا للـ Insulin.
Metformin is not tolerated or contraindicated (CI)
Initial monotherapy
اختار واحد:
Gliptin.
Sulfonylurea.
Pioglitazone.
Dual therapy
إذا HbA1c أكبر من (7.5%):
Gliptin + Pioglitazone.
Gliptin + Sulfonylurea.
Pioglitazone + Sulfonylurea.
Insulin
If HbA1c remains greater than 58 mmol/mol (7.5%)
نتنقلوا للـ Insulin.