Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Select Answer to see Preferred Response
This patient presents needing a second agent to achieve glycemic control and desiring to lose additional weight. Since GLP-1 mimetics have been shown to cause weight loss, exenatide would be the best choice as a second agent for this patient.
In patients with inadequate glycemic control on metformin and HbA1c >8.5%, a second pharmacologic agent may be added. The choice of a second agent depends upon multiple factors, including the risk of hypoglycemia and patient preference. A sulfonylurea like glipizide is often used, although a meglitinide (e.g. repaglinide), thiazolidinedione (e.g. pioglitazone), or GLP-1 agonist (e.g. exenatide) may also be used as second-line therapy. GLP-1 agonists in particular have been shown to cause weight loss and are often specifically used to take advantage of that side effect.
Answer 2: Glipizide is a sulfonylurea, which stimulates postprandial insulin release by closing the potassium channel on the beta-cell membrane. They have been shown to cause hypoglycemia and weight gain.
Answer 3: Repaglinide is a meglitinide, which similarly stimulates postprandial insulin release by binding to potassium channels on the beta-cell membrane. Like sulfonylureas, they have been shown to cause hypoglycemia and weight gain.
Answer 4: Pioglitazone is a thiazolidinedione (TZD), which increases peripheral insulin sensitivity by binding to the PPAR-gamma nuclear transcription regulator. They have been shown to cause weight gain, peripheral edema resulting in congestive heart failure, and increased risk of fractures.
Answer 5: Sitagliptin is a DPP-4 inhibitor, which inhibits the DPP-4 enzyme that deactivates GLP-1, thereby increasing glucose-dependent insulin release. They have a low risk of hypoglycemia but have been shown to be weight-neutral.
In patients that require a second medication to achieve glycemic control, the second agent is chosen based on patient preference, the risk of hypoglycemia, and other side effects, including effects on weight. GLP-1 agonists like exenatide have been shown to lead to weight loss.
Please Login to add comment