Reference no: EM132991872

Often we see a great deal of misinformation in the care of patients with diabetes, and often this misinformation is centered around the role and choice of medications. Many patients, especially newly diagnosed patients, are prescribed medications that do not fit into the scheme of the ADA / AACE guidelines / best evidence based practices - for instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin) or Byetta (exenatide) as initial monotherapy without a compelling indication or reason.

Question 1: Is it okay to start a patient on a drug (particularly an oral drug) other than metformin as an initial drug? Please cite possible circumstances where this could be reasonable.

Question 2: What anti-diabetic medications have compelling evidence for use in select populations, possibly as initial therapy, and is this benefit a "class" effect?

(eg. SGLT2Is - Patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo)

Question 3: How can patients and practitioners be convinced to change their behavior and opt for more evidence based approach to therapy?

• Now let's consider the following case about thyroid disorders. A 69-year-old man goes to his family doctor because he has been feeling fatigued and lethargic. His doctor does a complete evaluation. This patient had a myocardial infarction and has a recurrent ventricular arrhythmia (treated with amiodarone). The patient's TSH is elevated and his T4 is slightly decreased.