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 27/4/2012 10:50 PM BST
on bmj.com
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Posts: 461
First: 29/4/2011 Last: 31/5/2013 |
There is no right answer to that question. The essence of diabetes therapy is individualized treatment. Read my blog entitled a new bible for type 2 diabetes care and the joint EASD/ADA statement http://www.easd.org/easdwebfiles/statements/EASD_ADA%20position%20statement.pdf Basically the decision will rest upon what the patient is willing to,do, how,high his or her initial A1C is (the higher the more likely you would start a two-drug program). His or her hypoglycemia risk (sulfonylureas versus DPP-IV inhibitors). |
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Re: initial drug therapy in type 2 obese patients
posted at 2/5/2012 4:37 PM BST
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Hello abhijit pratap: I would try first progressively incresing doses of Metformin and serious Lifestyle Intervention. I would wait about 2-3 months with that. If I found it necessary later I usually add a newer generation sulfonylurea like extended release gliclazide. I usually do not use DPPIV-inhibitors. All Best, Joey |
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Re: initial drug therapy in type 2 obese patients
posted at 5/5/2012 4:21 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
A difficult to answer question Dr.Abhijit Pratap! I do agree with Dr. diabetesMD in this regard, that the essence of diabetes therapy is individualized treatment. Although metformin has been traditionally used in obese type II diabetics & is known to help reduce the weight, the monotherapy often does not provide a satisfactory glycemic control. Considering the comorbidities, a combination of oral hypoglycemic agents always achieve a good glycemic control, especially addition of glimepiride &/ or pioglitazone have been shown to be more effective than a monotherapy or only addition of a sulfonylurea. |
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Re: initial drug therapy in type 2 obese patients
posted at 6/5/2012 9:47 PM BST
on bmj.com
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Posts: 10
First: 27/4/2012 Last: 15/5/2012 |
In Response to Re: initial drug therapy in type 2 obese patients: A difficult to answer question Dr.Abhijit Pratap! I do agree with Dr. diabetesMD in this regard, that the essence of diabetes therapy is individualized treatment. Although metformin has been traditionally used in obese type II diabetics & is known to help reduce the weight, the monotherapy often does not provide a satisfactory glycemic control. Considering the comorbidities, a combination of oral hypoglycemic agents always achieve a good glycemic control, especially addition of glimepiride &/ or pioglitazone have been shown to be more effective than a monotherapy or only addition of a sulfonylurea. Posted by Dr. K. Ashutosh yes that is what we usually do, but we encounter a significant portion of patients who do no lifestyle modification , no matter how much u tell them, so we tried with combination and they would often not respond, biphasic insulin was given too but, repeated hypoglycemia episodes were found , and finally there sugar stabalised on metformin tds with extended release sulphonyureas, and the patient is quite happy ...... hence the question was put forward |
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Re: initial drug therapy in type 2 obese patients
posted at 6/5/2012 10:25 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
I do agree with you Dr.Abhijit Pratap that the combination of metformin & a sulfonylurea is a traditionally preferred treatment for patients, especially the elderly type II diabetics, in view of reduced incidence of hypoglycemia. But this combination is not always found to be effective, & more safe as well as effective modalities are available today in difficult to control the blood glucose levels. Thanks for a nice discussion! |
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Re: initial drug therapy in type 2 obese patients
posted at 6/5/2012 10:50 PM BST
on bmj.com
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Posts: 71
First: 3/4/2012 Last: 31/5/2012 |
I'm only a student, thus no expert, but I've just been revising diabetes. As far as I understand metformin is probably the safest drug considering it doesn't induce hypoglycaemia, and is associated with helping reduce weight loss. As far as I know, problems with compliance are related to its side effects of GI disturbances I.e. diarrhoea, vomitting etc. I would probably start off with lifestyle advise first if the serum glucose levels are borderline, and/or combine lifestyle advice with metformin. Please correct me if I'm wrong though. |
Forums » Open clinical » Diabetes » initial drug therapy in type 2 obese patients
