Concluded Case

Down titration of anti diabetic drugs

A 45 year old male, 175cm, 85kg wt, with pot belly, is a k/c/o diabetes for the past 6 years,he came to my opd with No complaints but FBS-180, PPBS-250,HBA1C 9%,, at his first visit to my OPD he was on Glymocomet Gp2 Bd and vildagliptin 50 mg OD His blood pressure is 130/80 on Olmax-H 40 OD His previous Fundoscopy 1 year ago revelaed no retinopathy ... His S.creatinine is 0.9, LFT normal,LIpid profile normal on Novastat Cv 20... I have checked for compliance with OADS and LSM he is taking OADS properly and walking everyday for atleast 45 minutes, unable to adhere to his dieticians advise I have put him on glycomet gp 3 BD and Galvus met 50/500 BD and vogliwock 0.2 before lunch and dinner... After 6 months,now his FBS-116,PPBS-190,HBA1C-6.8 without Documented hypoglycaemia.. Now my question is should I reduce the dose of his OADS / take out any OAD all together as his A1C is under control?? If so what to reduce and by how much? Any suggestions are most welcome,thanks in advance @Dr. Sepuri Krishna Mohan

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Concluded answer
Dear Mahesh, Thanks a lot fir for tagging me to answer your question. Coming to the case, continue all the Medicines as it is as everything is fine. Don't with draw any medication for Diabetes unless the patient C/O Hypoglycemic episodes in spite of regular diet including Mid morning snack Evening snack Late night snack. In that case reduce Tab Glimepiride to 2 mg from 3 mg. Continue rest all. Only Modification is 60 mts walk instead of 45 mts as per our Indian recommendations. Thanks again. Regards and thanks, Dr Sepuri Krishna Mohan.
All Answers
Dear Mahesh, Thanks a lot fir for tagging me to answer your question. Coming to the case, continue all the Medicines as it is as everything is fine. Don't with draw any medication for Diabetes unless the patient C/O Hypoglycemic episodes in spite of regular diet including Mid morning snack Evening snack Late night snack. In that case reduce Tab Glimepiride to 2 mg from 3 mg. Continue rest all. Only Modification is 60 mts walk instead of 45 mts as per our Indian recommendations. Thanks again. Regards and thanks, Dr Sepuri Krishna Mohan.
Valuable opinion,, Thank you so much sir
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Dear Dr @Mahesh Surabattuni , With advancing age & disease, gradually beta cells apoptosis advance for which persons with diabetes require more n more medicines. As per the recent reports of this case there is no requirement of reducing medicines, because the patient is doing well with this much of medicines without any side effects / hypoglycemia event.
Thank you doctor
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@Sepuri Krishna Mohan Sir if pt is already on glimipride 2 mg and metformin 500 with uncontrolled DM than it is better to shift on another class of drug or raising the dose of glimipride from 2 to 3 mg is better????? If pt not responding by raising the dose of glimipride to 2 mg or responds with minimal changes than can we say that this group doesnt works even we raise its dose from 2 to 3 mg??? And better to shift on another class of drug... sir eagerly waiting for ur reply
Dear Dr Akshay Mahalle, Wonderful question indeed. Stress more on Diet Exercise Weight Reduction Cessation of Smoking Cessation of Alcohol. Still not controlled, Increase the dose of the same molecule like Glimepiride 3 mg Plus Metformin 1000 mg. Add Tab Voglibose 0.3 mg to start with. If the patient has established ASCVD go for Either SGLT2 Inhibitors OR GLP1 Analogues OR Both in case there is no question of affordability. It doesn't mean that increased dose of Glimepiride doesn't work out, it's only Drug Effect, not Class Effect. You can try another SU At the same time you can add a drug of another Class like AGIs TZDs Insulins DPP4 Inhibitors SGLT2 Inhibitors GLP1 Analogues etc. Regards and thanks, Dr Sepuri Krishna Mohan
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Can we add empaglofizine with sitagliptin
Just minister how much wait he gaining
He maintained more or less the same weight,,, 6 months ago he was 85 now 86.5 ,, but i think it may be a natural variation in weight,, even my weight changes every other day by 1-1.5 kg depending upon the salt and carb content of the food i had eaten in the previous 2 days
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