Week 4 discussion resp 1 prac 6540
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Ms. Peters has been on Metformin, and her HgbA1c is 7.2%. Do you think it is time to introduce another anti-glycemic agent? If yes, which one, and why?
Hello Martha,
Great post, and to answer your question, I will add that long-term, most people with Type
2 diabetes (T2DM) will need drugs to attain and maintain glycemic control, even though lifestyle
adjustments, including dietary modification and increased physical activity, can be quite effective in improving glycemic control short term.
First-line treatment of type 2 diabetes mellitus often consists of biguanide metformin, which is effective alone and in conjunction with other glucose-lowering drugs. It has low costs, few adverse effects, and is safe for most people. It has low costs, few adverse effects, and is safe for most people. Although metformin's safety and efficacy have been established, there is debate about whether it should remain the primary choice for therapy because other anti-hyperglycemic drugs display significant advantages in some patient categories.
Metformin inhibits hepatic gluconeogenesis, decreases intestinal glucose absorption, enhances tissue glucose uptake, and elevates GLP-1 secretion are all mechanisms by which metformin lowers blood sugar levels(Baker et al., 2021
)
. Alterations in gut flora decreased inflammation, and fewer cases of cancer and depression are a few more of metformin's many benefits. Caenorhabditis elegans live longer after being treated with metformin. Metformin decreases mitochondrial complex I activity, leading to lower ATP levels, higher adenosine monophosphate (AMP) levels, and activation of AMP-activated protein kinase (Baker et al., 2021
)
.
Regarding Ms. Peters, I do not think she would benefit from adding another antihyperglycemic drug to her current regimen. Metformin, at a minimum dose of 500 mg daily, has been shown to reduce glycated hemoglobin (HbA1c) levels by an average of 0.9% (Baker et al., 2021
)
. The maximum metformin dose is 2500 mg, although most doctors only prescribe 2000
mg daily because going higher does not do much to lower HbA1c and causes more harmful effects. Her elevated HBA1C can be reduced to average with a dose increase of 2000 mg. Optimizing metformin to 2000 mg daily or the maximum tolerable lower dose improves glycemia in type 2 diabetes, according to a recent study, providing more evidence that metformin's efficacy is dose-dependent(Baker et al., 2021
)
.
Ms. Peters should be given a prescription with the increased dose and monitored for another three months with a repeat blood work to check for improvement. If there is none, then a second agent can be added. References
Baker,
C., Retzik-Stahr,
C., Singh,
V., Plomondon,
R., Anderson,
V., & Rasouli,
N. (2021). Should metformin remain the first-line therapy for treatment of type 2 diabetes?
Therapeutic Advances in Endocrinology and Metabolism
,
12
, 204201882098022.
https://doi.org/10.1177/2042018820980225
Feingold KR. Oral and Injectable (Non-Insulin) Pharmacological Agents for the Treatment of Type 2 Diabetes. [Updated 2022 Aug 26]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK279141/
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c. What is the appropriate treatment for the early stag
this condition?
DONOT
d. Given that she has been a diabetic
before she
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fong, why doesn't Maria realize she is in trouble
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39 words
A school-age child present with new-onset type 1 diabetes
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30)
X
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English (United States)
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SEE MORE QUESTIONS
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Recommended textbooks for you
- Essentials of Pharmacology for Health ProfessionsNursingISBN:9781305441620Author:WOODROWPublisher:CengageNutrition Through The Life CycleHealth & NutritionISBN:9781337919333Author:Brown, Judith E.Publisher:Cengage Learning,
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