Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario
In addition to lifestyle interventions, what is the best choice for the first antidiabetic drug in this patient’s treatment?
Discussion of Answers:
A. Incorrect. Explanation: There is low strength of evidence that nateglinide and alpha-glucosidase inhibitors are less efficacious in reducing HbA1c (~0.5-1% absolute difference) compared with other oral diabetes medications.
B. Incorrect. Explanation: There is moderate strength of evidence that metformin lowers HbA1c 0.5% better than dipeptidyl peptidase-4 inhibitors.
C. Incorrect. Explanation: According to the ADA/EASD consensus statement and algorithm for the treatment of Type 2 diabetes, lifestyle modifications and metformin would be recommended for this patient.
D. Correct. Explanation: This patient has no contraindications to the use of metformin, which may also may have a more favorable effect on his weight, an essential component of his treatment goals. This is also the recommendation of the ADA/EASD consensus statement.
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
- Bolen S, Wilson L, Vassy J, et al. Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes. Comparative Effectiveness Review No. 8. (Prepared by Johns Hopkins Evidence-based Practice Center under Contract No. 290-02-0018.) Rockville, MD: Agency for Healthcare Research and Quality. July 2007. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=40.
- Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32:193-203.
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