Endocrinology
Diabetes
Summary
- 72 year old female with uncontrolled DM (most recent A1c: 10.8)
- Patient was previously well managed on oral medication, Metformin 1000 mg BID.
- PCP is in the process of getting her approved for Ozempic and recently prescribed Pioglitazone 15 mg daily, however patient presents issues
- PCP would like medication recommendations to optimize the patient's care
eConsult Transcript
PCP submission
Patient is a 72 y/o caucasian female. She has uncontrolled DM with most recent A1c: 10.8. She was previously well managed on oral medication, Metformin 1000 mg BID. She has had financial trouble which led to utilizing a food bank which provided a lot of high carb foods (white bread, pasta, rice). We are in the process of getting her approved for a patient assistance program for Ozempic. I recently prescribed Pioglitazone 15 mg daily, however patient presents today with c/o increased shortness of breath with activity. She is on Albuterol PRN and Symbicort BID. Increased shortness of breath seems to have started after Pioglitazone was initiated. Patient has an allergy to sulfa which eliminates Glipizide and Glimepiride.
Could you please provide medication recommendations to optimize this patient’s care?
Specialist response
Thanks for the consult. Pt will benefit from starting sglt2-i jardiance 25 mg once daily and stop pioglitazone (can exacerbate CHF). Her microalb/cr in urine is >30 and evidence of early kidney damage in diabetes is there. So, she will benefit on jardiance or farxiga w proven cardiovascular and renal benefit.
(Ref. Use of sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors: An Asian perspective and expert recommendations Chaicharn Deerochanawong MD, Siew P. Chan MD, Bien J. Matawaran MD, Wayne H.-H. Sheu MD, Juliana Chan MD, Nguyen H. Man MD, Ketut Suastika MD, Chin M. Khoo MD, Kun-Ho Yoon MD, Andrea Luk MD, Ambrish Mithal MD, Ji Linong MD First published: 02 July 2019)
