initial drug therapy in type 2 obese patients
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Diabetes
initial drug therapy in type 2 obese patients
Discuss any aspect of type I or type II diabetes mellitus here
should an obese patient with type 2 dm, be tried with metformin alone and tried with tds dose or should the initial choice should be a combination with sulphonylureas
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Cat:OpenClinicalForum:209c1fee-a6e1-4cf9-9bd5-7d4dd5443e39
Cat:OpenClinicalForum:209c1fee-a6e1-4cf9-9bd5-7d4dd5443e39Discussion:c929201a-b435-4e63-88cf-265976500bda
Forums » Open clinical » Diabetes » initial drug therapy in type 2 obese patients
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Re: initial drug therapy in type 2 obese patients
posted at 7/5/2012 12:39 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hello researchPO: I agree with you, and I would add that in my own clinical practice most obese type 2 diabetics have been living with some degree of low or even moderate hyperglycaemia for a while before the diagnosis of diabetes is done. I think we should always remember UKPDS 34 in these patients together with Lifestyle intervention. And I usually prioritize a global cardiovascular risk reduction strategy trying to optimize lipids&hypertension control firstly. Regarding Hyperglycaemia I just tell them that it is just a number, I try to explain to them that it is just a surrogate for diabetic complications, that it will go down as time goes by with no hurry, but that it will probably never get back to "normal" values, because at these normal levels they will be at risk for developing Hypoglycaemias that is a much more serious condition. All Best, Joey
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Re: initial drug therapy in type 2 obese patients
posted at 7/5/2012 10:47 AM BST
on bmj.com
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Posts: 71
First: 3/4/2012 Last: 31/5/2012 |
Hello Joey Rio, thank you for your post. Yes, I think assessing cardivascular risk is of great importance considering diabetes is more a cardiovascular disease than endocrinology condition; simply because patient morbidity and mortality is related more to the impact on the cardivascular system. Thus I believe statins play a huge role for those with high cholesterol, which is often the case with obese patients. Measuring BP and weight is important too, and also anti-hypertensives play a role. Ultimately, I guess lifestyle advice inc weight loss is key, especially with borderline patients. I know a patient who was borderline, seriously tipping into hyperglycaemia/diabetes, and with some education on lifestyle changes, she lost a lot of weight and her blood sugars returned to a safer range. I think with diabetes there is a window of opportunity to change the course of the condition around just as there is more atheroscleorosis; so education on lifestly advice is massively important for these patients. I suppose these interventions come first before any drug (aka poison) is ever used. |
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Re: initial drug therapy in type 2 obese patients
posted at 8/5/2012 5:42 AM BST
on bmj.com
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Posts: 10
First: 27/4/2012 Last: 15/5/2012 |
dr researchPO, what u mentioned is right, in type 2 diabetes the insulin resistance in the main culprit and obesity increases that, hence the emphasis on dietary and lifestyle modification, and metformin also increases the peripheral utilization of insulin... thank u everyone for your valuable opinions |
Forums » Open clinical » Diabetes » initial drug therapy in type 2 obese patients
