Case Study – Type 2 Diabetes (T2DM)Treatment and Management

Case Study – Type 2 Diabetes (T2DM)Treatment and Management

The case presented is of a 64-year-old lady with T2DM, hypertension, and hyperlipidemia who was on Metformin, Thiazide Diuretic, ACE inhibitor and Atorvastatin. Nonetheless, she continues to suffer from her health problem, and her A1C is still high and currently is 7. 8 percent, which shows that she might need a change in her diabetes treatment regimen. This paper aims to provide a framework to support and optimize the clinical and socio-economic management of T2DM in culturally diverse populations. Further, this discussion will focus on three treatment modalities that will be considered according to the current evidence-based practice, considering their strengths, weaknesses, and relevance to Match’s financial status and culture.

Treatment Option 1: Intensification of Metformin Therapy with a GLP-1 Receptor Agonist

Medication: Liraglutide (Victoza)

Dosage: Start with 0.6 mg subcutaneously once daily, increasing to 1.2 mg after one week, and further to 1.8 mg if needed based on glycemic response

Route: Subcutaneous

Frequency: Once daily

Benefits

            When used with metformin, liraglutide, a GLP-1 receptor agonist, has been endorsed by both the American Diabetes Association and the American Association of Clinical Endocrinologists for patients whose A1C levels have not been well controlled with monotherapy alone. This class of drugs not only enhances glycemic control but also provides cardiovascular benefits, which are valuable in view of the patient’s hypertension and hyperlipidemia. Further, liraglutide is also effective in weight reduction and thus may help manage the patient’s BMI of 32 kg/m² (Feingold, 2022).

Drawbacks

The main limitation is the cost of liraglutide, which may not be affordable to this patient since she is struggling to pay her bills from the small pension she receives and from her late husband’s disability payments. The frequency of administering the medication through injections and possible side effects on the gastrointestinal tract may also play a crucial role in affecting adherence, taking into account the patient’s limited understanding and use of English, which may lead to difficulties when describing the correct injection technique (Mehta et al., 2019).

Treatment Option 2: Addition of a Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitor

Medication: Empagliflozin (Jardiance)

Dosage: 10 mg orally once daily, may increase to 25 mg if necessary

Route: Oral

Frequency: Once daily

Benefits

Another type of antidiabetic drug that the ADA and AACE endorse for T2DM is empagliflozin, an SGLT-2 inhibitor aimed at patients with cardiovascular disease comorbidities. It is proven to effectively drop blood glucose levels and opens a number of other possibilities, including the prevention of heart failure and slight weight loss. It may be administered orally, which might be more appropriate for the patient than injectable forms of treatment (Padda et al., 2023).

Drawbacks

Some concerns may remain due to the cost of empagliflozin; however, the cost may be lower compared to the GLP-1 receptor agonists. Another potential complication is the development of a urinary tract infection, which may be more of a concern in elderly patients. Additionally, the patient should be encouraged to drink enough water to rule out volume depletion, especially knowing that the patient is not young and cannot rely on healthcare advice since, most of the time, the staff communicates in a foreign language (Ramos et al., 2020).

Treatment Option 3: Initiation of Basal Insulin

Medication: Insulin Glargine (Lantus)

Dosage: Start with ten units subcutaneously once daily, titrating based on fasting blood glucose levels (Cunningham & Freeman, 2022).

Route: Subcutaneous

Frequency: Once daily

Benefits

Insulin glargine is a basal insulin that can provide consistent 24-hour blood glucose control, making it a reliable option for patients who have not achieved glycemic targets with oral medications alone. It is generally well-tolerated and can be titrated to achieve desired blood glucose levels (Donner & Sarkar, 2023).

Drawbacks

The major drawback is the risk of hypoglycemia, which can be particularly dangerous in elderly patients. The need for daily injections and regular monitoring of blood glucose levels could also be challenging for this patient, especially considering her limited English proficiency and the need for translation services. Additionally, insulin therapy can be costly, and the patient’s financial situation may limit her ability to afford this treatment (Donner & Sarkar, 2023).

Local Resources for Diabetes Management in Upland, California

San Bernardino County Department of Public Health – Diabetes Program

This program provides a series of free diabetes education classes, nutritional consultations and support groups for diabetics. It can also help in accessing affordable medicines and supplies as indicated in the following subcategory (Forycka et al., 2022).

Link: San Bernardino County Diabetes Program

Arrowhead Regional Medical Center – Diabetes Management Center

This center provides all forms of diabetic care, such as teaching, dietary management, and help in managing medication. Low-cost stocks and medicines are also available to people in need of them (Bosetti et al., 2021).

Link:  Arrowhead Regional Medical Center Diabetes Center

City of Hope – Diabetes & Metabolic Research Institute

This institute, present near Upland, provides patients with the possibility to participate in clinical trials, receive information about diabetes and get the necessary medications and equipment at lower prices thanks to their patient aid programs (Gourdy et al., 2023).

Link: City of Hope Diabetes Program

Conclusion

When managing T2DM in this patient, one needs to consider both glycemic control and the patient’s financial and cultural status. The three treatments discussed—the addition of a GLP-1 receptor agonist, an SGLT-2 inhibitor, and the initiation of basal insulin therapy—have their own advantages and limitations. The choice should be made according to patients’ preferences, costs, and possibilities to follow the prescribed regimen based on the outcomes of the search and comparison of the most recent clinical guidelines and available resources in Upland, California.

References

Bosetti, R., Tabatabai, L., Naufal, G., Menser, T., & Kash, B. (2021). Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review. PLOS ONE, 16(11), e0260139. https://doi.org/10.1371/journal.pone.0260139

Cunningham, A. M., & Freeman, A. M. (2022). Glargine Insulin. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557756/

Donner, T., & Sarkar, S. (2023). Insulin – Pharmacology, Therapeutic Regimens, and Principles of Intensive Insulin Therapy. Nih.gov; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK278938/

Feingold, K. R. (2022, August 26). Oral and Injectable (Non-insulin) Pharmacological Agents for Type 2 Diabetes (K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, K. Dungan, A. Grossman, J. M. Hershman, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, R. McLachlan, J. E. Morley, M. New, L. Perreault, J. Purnell, R. Rebar, F. Singer, D. L. Trence, & A. Vinik, Eds.). PubMed; MDText.com, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279141/

Forycka, J., Hajdys, J., Krzemińska, J., Wilczopolski, P., Wronka, M., Młynarska, E., Rysz, J., & Franczyk, B. (2022). New Insights into the Use of Empagliflozin—A Comprehensive Review. Biomedicines, 10(12), 3294. https://doi.org/10.3390/biomedicines10123294

Gourdy, P., Darmon, P., François Dievart, Halimi, J.-M., & Guerci, B. (2023). Combining glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) in patients with type 2 diabetes mellitus (T2DM). 22(1). https://doi.org/10.1186/s12933-023-01798-4

Mehta, A., Marso, S. P., & Neeland, I. J. (2019). Liraglutide for weight management: a critical review of the evidence. Obesity Science & Practice, 3(1), 3–14. https://doi.org/10.1002/osp4.84

Padda, I. S., Mahtani, A. U., & Parmar, M. (2023). Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK576405/

Ramos, M., Cummings, M. H., Ustyugova, A., Raza, S. I., de Silva, S. U., & Lamotte, M. (2020). Long-Term Cost-Effectiveness Analyses of Empagliflozin Versus Oral Semaglutide, in Addition to Metformin, for the Treatment of Type 2 Diabetes in the UK. Diabetes Therapy, 11(9), 2041–2055. https://doi.org/10.1007/s13300-020-00883-1

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Week 5: Discussion Question – Chronic Illness
Discussion Topic

Imagine a 64-year-old woman from a different cultural background than the healthcare provider. She has been living with type 2 diabetes (T2DM) for two years. She has been taking metformin (2000 mg/day) without any issues. Her BMI is 32 kg/m². She also has high blood pressure (hypertension), which is well managed with a thiazide and an ACE inhibitor. Her cholesterol levels are under control with atorvastatin 10 mg. She doesn’t smoke, drink, and is up-to-date with her vaccinations. However, her recent A1C reading is 7.8%.
This patient is widowed and relies on her late husband’s disability payments and a small pension. She’s worried about the cost of any new medications. She primarily speaks her native language, with limited proficiency in English, and sometimes her son accompanies her for translation.

Here is the instructions:

Discuss and evaluate at least three treatment options, considering the benefits and drawbacks, based on the latest clinical guidelines and evidence. Include any other essential considerations.

– Please kindly put an introduction before you put the three treatments.
– Please put the three treatments in an organize outline. Please specify and be specific with the medication as like with name, dosage, route and frequency. Please use the latest clinical guidelines and evidence.
– Please do not forget to put intext citations on paragraphs, especially on each treatments since it comes from clinical guidelines.

Some latest clinical guidelines: This is sample but you can research on the latest guidelines and evidence base.

American Diabetes Association. (2023). Standards of Medical Care in Diabetes—2023. Diabetes Care, 46(Supplement_1), S1-S291. Link to Article

American Association of Clinical Endocrinology (AACE). (2023). Comprehensive Type 2 Diabetes Management Algorithm. Endocrine Practice, 29(1), 1-20. Link to Article

Additionally, in your response, list three specific programs or organizations in your city that can assist her in obtaining low-cost or free diabetes supplies, medications, or other diabetes-related resources. Include links to these unique resources in your area.

– Please find link or resources in my area in Upland California at least three programs or organizations in our city. (UPLAND, CALIFORNIA) or San Bernardino County. Please explain what they offer or other resources.
–
In addition to your links, list high-level scholarly references to support your clinical decision making. Do not use point-of-care references for this discussion. Please use only clinical guidelines and evidence base references. Do not use .coms

Expectations
Initial Post:

• Length: A minimum of 550 words, not including references
• Citations: At least three high-level scholarly reference in APA from within the last 5 years