Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario
Informed Decisionmaking: Treatment Options
You then discuss with him the treatment options going forward. Which of the following lines of information do you use to help inform his decision?
Discussion of Answers:
A. Incorrect. Explanation: All of these options are correct.
B. Incorrect. Explanation: All of these options are correct.
C. Incorrect. Explanation: All of these options are correct.
D. Correct. Explanation: Evidence suggests that several combination therapies have similar efficacy at reducing HbA1c. The issue of whether the patient will accept the trade-off of visible fat weight gain is one that he himself needs to make on the basis of a frank discussion of the evidence. There is moderate strength evidence that metformin + a second-generation sulfonylurea will have a more favorable effect on weight when compared to metformin + a thiazolidinedione by -0.9 kg. There is also low strength evidence that adding a GLP-1 agonist or DPP-4 inhibitor may have a more favorable effect in weight when compared to the combination of metformin + thiazolidinedione.
Keywords: informed decisionmaking | treatment | type 2 diabetes | blood glucose | weight gain | combination therapy
- 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.
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