Case Study-Treatment Options For Diabetes

The aim of treatment is to bring the HbA1c to target value of 6.5% in a diabetic patient, and to educate the patient in terms of lifestyle modifications such as diet, exercise and to monitor their own plasma glucose levels to reach the target range. The treatment option should be according to patient’s acceptance and cost effective. The following steps are recommended if HbA1c is not below 7.5%:

• Take metformin, if it does not control HbA1c alone, and add sulfonylurea as well. If any of these drugs not accepted by the patient due to unwanted side effects such as nausea or hypoglycemia, thiazolidinedione can be added in place of any of these drugs. A rapid acting insulin secretagogue can be added if the patient has erratic lifestyle, as it requires once daily dosing.
• Add insulin or a thiazolidinedione (if insulin is not accepted by the patient). Exenatide may be considered if the criteria is met, that is BMI >35kg/m², on a cost effectiveness basis.
• Intensify insulin regimen overtime and take with pioglitazone if thiazolidinedione was effective previously or high dose insulin alone is ineffective.