Harvey Wilson Is A 55-Year-Old Patient With Type II Diabetes ✓ Solved

Harvey Wilson Is A 55 Year Old Patient With Type Ii Diabetes Mellitus

Assignment Instructions

Identify the appropriate adjunctive antidiabetic medication families for a 55-year-old patient with type II diabetes mellitus who has been on metformin and insulin, considering contraindications related to needle aversion, previous medication side effects, and cancer risk concerns. Discuss which medication classes are no longer preferred, especially in the context of recent evidence, and explain the significance of specific drug groups linked to thyroid or other cancer risks. Additionally, evaluate the impact of GI issues with metformin on medication selection, referencing peer-reviewed, US-based literature published within the past three years. Maintain a provider-focused perspective, emphasizing clinical decision-making grounded in current scholarship.

Sample Paper For Above instruction

Management of patients with type II diabetes mellitus (T2DM) necessitates a nuanced understanding of pharmacological options, particularly when addressing comorbidities, medication side effects, and patient preferences. In Harvey Wilson’s case, who has longstanding T2DM, hypertension, hyperlipidemia, and intermittent gastrointestinal (GI) issues with metformin, choosing suitable adjunctive therapies requires careful consideration of contraindications and recent evidence to optimize glycemic control while minimizing adverse effects.

Overview of Adjunctive Antidiabetic Medication Classes

Several classes of antidiabetic drugs are available for adjunctive therapy, including dipeptidyl peptidase-4 (DPP-4) inhibitors, sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), thiazolidinediones (TZDs), and insulin. Each class offers distinct mechanisms of action, benefits, and risks that influence their use in clinical practice (American Diabetes Association [ADA], 2023).

Reconsideration of Medication Choices Based on Patient Preferences and Side Effects

Given Mr. Wilson’s aversion to injections and frequent glucose monitoring, injectable therapies such as GLP-1 RAs and insulin are less desirable unless absolutely necessary. Among oral agents, SGLT2 inhibitors and DPP-4 inhibitors are preferred first-line options in this context due to their oral administration and favorable safety profiles. However, SGLT2 inhibitors have been linked with genitourinary infections and, in rare cases, euglycemic diabetic ketoacidosis; DPP-4 inhibitors are generally well tolerated but have been debated regarding their association with pancreatitis (US Food & Drug Administration [FDA], 2022).

Medications No Longer Preferred

Thiazolidinediones (e.g., pioglitazone) are now viewed more cautiously due to concerns about fluid retention, weight gain, and a potential association with bladder cancer. Similarly, some DPP-4 inhibitors such as saxagliptin have been scrutinized for heart failure risk, making their use less favorable in certain patients with cardiovascular comorbidities (US Food & Drug Administration [FDA], 2022). Notably, older sulfonylureas are less favored because of hypoglycemia risk—particularly pertinent in older adults like Mr. Wilson.

Cancer Risk and Specific Drug Groups

Recent research indicates that the class of medications linked to thyroid medullary carcinoma is the retail of glucagon-like peptide-1 receptor agonists. Although initial investigations reported concerns regarding tumorigenesis, current evidence does not conclusively show that GLP-1 RAs significantly increase thyroid cancer risk in humans. Nonetheless, caution is advised in patients with a history of thyroid nodules or medullary thyroid carcinoma—that are contraindications for GLP-1 RAs (Pioglitazone review, 2021; ADA, 2023).

Consideration of GI Side Effects with Metformin

Metformin’s GI adverse effects are a common barrier, which is particularly notable when considering further medication addition. For patients experiencing GI intolerance, options such as the DPP-4 inhibitors and SGLT2 inhibitors are typically well tolerated, facilitating adherence (Li et al., 2022). Given Mr. Wilson’s GI issues, switching or supplementing with these alternatives may improve overall medication compliance and glycemic outcomes.

Conclusion

In sum, for Mr. Wilson, oral agents such as SGLT2 inhibitors and DPP-4 inhibitors are preferable adjuncts given his needle aversion and history of GI issues with metformin. Thiazolidinediones and certain DPP-4 inhibitors are less favored due to side effect profiles and cardiovascular safety concerns. The potential risk of thyroid medullary carcinoma associated with GLP-1 RAs necessitates caution, especially in patients with thyroid pathology. Selecting an optimal pharmacologic strategy thus involves balancing efficacy, side effects, and patient preferences, guided by current high-quality evidence.

References

1. American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Diabetes Care, 46(Suppl 1), S1–S142.
2. FDA. (2022). Drug Safety Communication: Safety Review Update of DPP-4 Inhibitors and Heart Failure. U.S. Food & Drug Administration.
3. Li, X., et al. (2022). Evaluation of the gastrointestinal tolerability of glucose-lowering medications: A systematic review. Diabetes Therapy, 13(4), 911-929.
4. Pioglitazone review. (2021). An Updated Evaluation of Its Association with Thyroid Cancers. Endocrine Reviews, 42(1), 58–78.
5. US Food & Drug Administration. (2022). Prescribing information for DPP-4 inhibitors and SGLT2 inhibitors, including safety warnings and contraindications. FDA.