Managing Diabetes

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Discussion – Managing Diabetes Essay.

Discussion – Managing Diabetes

Starting a Patient on Hypoglycemic Drugs Other Than Metformin

Currently existing guidelines recommend metformin as the initial first line drug of choice in managing patients with type 2 diabetes mellitus. Therefore, it can be wrong to start a patient on other oral antidiabetic drugs other than metformin. The main exclusions to this guideline recommendation include clinical conditions that can compromise the patient’s safety by inducing adverse effects.Discussion – Managing Diabetes Essay.


These situations include; patients with chronic kidney disease, severe infection, heart failure and hepatic failure are contraindications for metformin use. Studies by Chung et al. (2020) show that any intended use of metformin for a dehydrated patient or one with a glomerular filtration rate less than 60mL/min/1.73m2 should be done with caution. However, a GFR less than 30mL/min/1.73m2 is a contraction for metformin use. Besides, a patient with anemia or peripheral neuropathy should not receive on metformin as an initial drug unless their Vitamin B12 measurement is normal (200-900pg/mL). According to the American Diabetes Association (2019), metformin is associated with anemia and vitamin B12 deficiency. Such contraindications warrant for the use of other oral drugs, which show more cardiovascular diseases prevention and pose fewer side effects.Discussion – Managing Diabetes Essay.

Anti-Diabetic Medications with Compelling Evidence For Use

DPP4 inhibitors such as sitagliptin have convincing evidence for use due to their low incidence of causing hypoglycemia. Studies by Rhee et al. (2017) show that sitagliptin has a neutral effect on cardiovascular diseases and can be used for patients with a heart failure condition. The use of SGLT2 inhibitors has led to a marked reduction of cardiovascular disease risk. Randomized controlled trails by Rhee et al. (2017) have proved that SGLT2 inhibitors reduce mortality in type 2 diabetic patients with cardiovascular diseases.Discussion – Managing Diabetes Essay.

Convincing Patients and Practitioners to Opt For Evidence-Based Approach

Some practitioners put newly diagnosed patients with diabetes on medications, which do not fit ADA/AACE guidelines. Such practitioners may be unaware of revised guidelines and inconsiderate of patients’ needs or preferences. The knowledge created from qualitative, quantitative studies and randomized controlled trials should be disseminated to these practitioners with an authoritative seal of approval by professional organizations. Practitioner and patient education are vital in ensuring the adoption of developed clinical guidelines (Chung et al., 2020). The influence will create demand for application of evidenced approach and reduce medication errors.Discussion – Managing Diabetes Essay.


American Diabetes Association. (2019). 9. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes—2019. Diabetes care, 42(Supplement 1), S90-S102.

Chung, W. K., Erion, K., Florez, J. C., Hattersley, A. T., Hivert, M. F., Lee, C. G., … & Franks, P. W. (2020). Precision medicine in diabetes: a consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 63(9), 1671-1693.

Rhee, S. Y., Kim, H. J., Ko, S. H., Hur, K. Y., Kim, N. H., Moon, M. K., … & Kim, J. H. (2017). Monotherapy in patients with type 2 diabetes mellitus. Diabetes & metabolism journal, 41(5), 349.

Discussion – Managing Diabetes Essay.