Diabetes mellitus overview
Type 2 diabetes mellitus (or just diabetes) is a chronic, progressive condition primarily characterised by two metabolic dysfunctions: insulin resistance and relative insulin deficiency.1
After reading this article, pharmacists should be able to:
Competencies (2016) addressed: 1.1, 3.1, 3.2, 3.2, 3.3, 3.6.
Helen is a 63-year-old woman (height 162 cm, weight 84 kg) with chronic heart failure (NYHA Class 1), hypertension and type 2 diabetes (diagnosed five years ago).
The medicines Helen is currently taking is shown in the table (below), along with pathology results from one month ago.
Helen commenced glibenclamide around 12 months ago when her glycaemic control had been consistently suboptimal, despite taking metformin. She has been taking the current dose for 6 months, but her HbA1c has not reduced appreciably and she has gained 3 kg in weight.
Helen comes into the pharmacy to pick up her repeats, and discusses her diabetes control with you. She reports taking her medications daily and that gaining better control of her diabetes is a priority. However, she states: ‘I am not ready to start injecting myself and prefer to stick to pills.’ She wants to know more about the possibility of adding a third glucose-lowering agent.
This article presents an overview of options available to Helen, with an emphasis on recent evidence on the beneficial effects of some newer agents.
|Medicine name and strength||Directions|
|Glibenclamide 10 mg||One tablet in the morning|
|Lisinopril 20 mg||One tablet in the morning|
|Metformin 1,000 mg||Two tablets twice daily|
|Metoprolol SR 190 mg||One tablet in the morning|
|Pathology results (reference range) from one month ago|
|Blood pressure||136/80 mmHg (<120/80 mmHg)|
|Sodium||135 mmol/L (135–145 mmol/L)|
|Potassium||4.5 mmol/L (3.4–5.5 mmol/L)|
|Urea||8.3 mmol/L (2.9–8.2 mmol/L)|
|Creatinine||89 micromol/L (40–95 micromol/L)|
|Fasting BGL||7.2 mmol/L (4.0–6.0 mmol/L)|
|Urinary albumin: creatinine ratio||2.1 mg/mmol (<3.5 mg/mmol (female))|
|Total cholesterol||3.5 mmol/L (<5.5 mmol/L)|
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