Transitioning to non-insulin therapy in a patient receiving high dose insulin
Autor: | Shivajirao P. Patil, James R. Powell, Carlos E. Mendez, Basem M. Mishriky, Doyle M. Cummings |
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Rok vydání: | 2020 |
Předmět: |
Male
Pediatrics medicine.medical_specialty medicine.medical_treatment Type 2 diabetes Disease Hypoglycemia 03 medical and health sciences High dose insulin 0302 clinical medicine Insulin resistance Diabetes mellitus medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine General Nursing Glycemic Glycated Hemoglobin 030504 nursing business.industry General Medicine Middle Aged medicine.disease Diabetes Mellitus Type 2 Insulin Resistance 0305 other medical science business |
Zdroj: | Journal of the American Association of Nurse Practitioners. 32(6) |
ISSN: | 2327-6924 |
Popis: | In people with type 2 diabetes with evidence of obesity-related insulin resistance, use of insulin to treat hyperglycemia has not been shown to reduce macrovascular complications, despite widespread use for many years. However, newer classes of diabetes medications, designed to address the prevalent pathophysiologic defect of type 2 diabetes, have emerged. Consequently, in many patients, reduction of insulin doses or even total elimination is possible after the addition of these newer agents. The authors suggest a cautious approach in which people with type 2 diabetes and established cardiovascular disease who are on high insulin doses (>1.0 unit/kg/day) be treated with diabetes medications that showed evidence of cardiovascular benefit (such as glucagon-like peptide-1 receptor agonists [GLP-1RAs]), on whom close monitoring is crucial because they may be at particular risk for developing hypoglycemia. This approach can be labor intensive and may be challenging for busy primary care providers for who may have limited time to evaluate and follow the patient. The authors present a case report of adding a GLP-1RA to high insulin doses. If the hemoglobin A1c is |
Databáze: | OpenAIRE |
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