Review Question: An Obese Patient with Diabetes
Q. A 56-year-old white woman presents to your office with several complaints of a few weeks’ duration. She notes morning blurred vision that resolves within several hours. She denies having headaches, chest pain, dizziness, or any recent changes in her diet. She has been trying to lose weight and has been pleasantly surprised to see that, according to your office scale, she has lost 10 lb in the past 4 weeks. She is a well-nourished, slightly obese woman holding a bottle of water. Her blood pressure is 118/74 mm Hg. The remainder of the physical examination is unremarkable. You suspect she may be diabetic, which you confirm with a random measurement of blood glucose level at 212 mg/dL and a fasting blood glucose level of 139 mg/dL.
In addition to a consultation with a dietitian, which of the following diabetes medications would be the most appropriate for this patient?
A. Rosiglitazone maleate (Avandia)
B. Metformin HCl (Glucophage)
C. Lente insulin
D. Glipizide (Glucotrol)
E. Acarbose (Precose)
Answer to review question (from page 1)
B.Patients recently diagnosed with type 2 diabetes or with impaired glucose tolerance should be given clear goals for diet and exercise. This type of diabetes involves beta-cell fatigue and an insulin decrease, along with peripheral receptor insensitivity. In patients who are not obese, sulfonylureas are an excellent first choice, since they address both pathways. In obese patients, as in the case of this patient, metformin HCl would be the best choice of the options given. It has recently gained favor because of its ability to reduce triglycerides, increase peripheral adipocyte sensitization, and decrease hepatic glucose production. There is also evidence that metformin may reduce the incidence of cardiovascular events in persons with diabetes.
1. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2005;28(suppl 1):S4-S36.