Posted in Diabetes at Wed, 04 May 2016 13:50:44
Joined: 13 Apr 2011
In Response to Re: Clinical question of the week: would you change this man’s anti-diabetic treatment?:[QUOTE]
1} I will like to add SGLT2 inhibitor to MFN WHICH SHOULD HELP HIM TO REDUCE WEIGHT,may help to reduce BP medication and reduce his cardiac risk
2} Statin may have aggrevated diabetes.I will try Pitavastatin which may be superior to Rosuva in Diabetic
Posted by pdg53[/QUOTE]
1. SGLT2 Inhibitors were not one of the possible answers in our clinical case because my decision was for having 1 option for the traditional oral anti-diabetic drugs (sulphonylureas), another 1 option for the newer anti-diabetic drugs (DPP-4-Inhib.), and one option for not adding any other anti-diabetic drug. But we should be aware that there is no long-term randomised clinical trial evidence, that I am aware of, that SGLT2 Innhibitors are effective and safe in patients with no established cardiovascular event, like this one presented here in our case discussion. See the recent EMPA-REG trial recently published in the NEJM that was done with patients with post acute coronary syndromes.
2. You reached the target, and made the right diagnosis! This case here presented is indeed one of Statin-induced worsening glycaemic control. Pitavastatin could be a right therapeutic option also. Our patient choosed the generic atorvastatin, in a lower dose, than the previous higher dose of rosuvastatin, and succeeded regarding his glycaemic control.