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

Metformin first choice to treatment type 2 DM

تبوا شرح Diabetes Mellitus

ممكن يمشي معاكم الشرح وتفهموا

نشرحلكم من الديغرام هذا

اول مرة خوذوا هاذي

وصلت الفكرة

تبوا الكلام مكتوب

#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.

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.

وضحت الفكرة والا نفرغ في الهواء 😔

نديرلكم صور زي هك