Partnering With Patients to Optimize Diabetes Therapy
Selecting diabetes medications based on how they can best address the patient’s hyperglycemic pattern is a glucose-centric approach. Perhaps even more important to the overall success of diabetes management, however, is the clinician’s ability to partner with the patient to choose the appropriate agent. Here is a pragmatic framework demonstrating both glucose- and patient-centric approaches you can use when selecting diabetes medications.
PATIENT PRESENTATION/HISTORY
We will explore a combined glucose-centric/patient-focused approach with our patient, Sonja.
Sonja is a 38-year-old Latina woman who was diagnosed with T2DM one week ago. She was being closely monitored for diabetes due to a strong family history for T2DM (father, two sisters, and several aunts/uncles affected), high-risk ethnicity, and history of gestational diabetes. Two years ago, when she was told she had prediabetes, she attempted to make appropriate therapeutic lifestyle changes.
Sonja is significantly overweight, with a BMI (29) bordering on obesity. She is inconsistent in her approach to exercise, and her long working hours as a dentist have contributed to a sedentary lifestyle. However, she made a concerted effort to change her diet and successfully lost 18 lb in the past year. Unfortunately, she then experienced considerable stress in her personal life and regained the weight, plus an additional 6 lb.
She presents today to review recent laboratory test results, which include a fasting glucose of 133 mg/dL; serum creatinine (SCr), 1.0 mg/dL; estimated glomerular filtration rate (eGFR), 103 mL/min; A1C, 7.2%; and aspartate transaminase/alanine transaminase (AST/ALT), normal. Sonja says she feels “defeated, frustrated, and helpless” in her attempt to control her weight and thus her inability to avoid T2DM. Fortunately, she wants to change and is determined to do whatever is necessary.
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