There are lots of different medications utilized in type 2 diabetes.  Finding that perfect combination can be a challenge, and what has worked for them in the past may not always necessarily work in the future as things change.  Here I demonstrate the importance of looking back as to why a patient isn’t on a medication and what might be advantageous add on diabetes therapy to insulin management.

A 59 year old female has a 10+ year history of Type 2 diabetes.  She is currently on insulin glargine 20 units twice daily.  Weight gain has been a concern for the patient as she has gain 20 pounds in the last year.  Her A1C remains elevated at 8.8.  She knows that she has been on a bunch of different oral medications prior to her insulin therapy.  She hasn’t been on a GLP-1 that she can recall which is a potential option.

When discussing medications, it is so important to do a thorough look back whenever possible.  When questioned about metformin, she did say she was on it, but when asked about why it was discontinued, she did not really know why.  Her kidney function has been historically stable and within normal limits and she doesn’t recall an allergy or intolerance.

Upon further investigation into the medical record, it was noted that she was metformin up until a procedure where she received contrast dye.  The metformin was held at that time and not restarted upon discharge.

This is a classic example of miscommunication, and/or inadvertent error that led to elevations in A1C and potentially a significant extra cost to the healthcare system if we would have to use a GLP-1 in the place of metformin.

 
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