Question
A 67-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. His only medication is metformin. He has tried to lose weight for several years without success. He is 168 cm tall and weighs 110 kg ; BMI is 39 kg/m2. His hemoglobin A1c is 8.5%. Which of the following is the most appropriate antidiabetic drug to address both this patient’s glucose control and weight?
| A. |
Miglitol
|
| B. |
Glipizide
|
| C. |
Liraglutide
|
| D. |
Nateglinide
|
Show Answer
|
Correct Answer � C
Explanation
|
|
Ans-C-Liraglutide
Miglitol
Miglitol, an alpha-glucosidase inhibitor, is not associated with weight loss and is therefore not the most appropriate medication for this patient.
Glipizide
Glipizide is a sulfonylurea, a class of drugs known to cause weight gain. Moreover, the use of sulfonylureas with biguanides such as metformin is associated with an increased risk of hypoglycemia, especially in patients older than 65 years.
Liraglutide
Liraglutide, which is a GLP-1 agonist, can facilitate weight loss and control hyperglycemia. Incretin-based therapeutic agents such as GLP-1 agonists also have the additional benefit of carrying only a low risk of medication-induced hypoglycemia. Besides metformin and GLP-1 agonists, other drugs that can be used for weight loss in diabetic patients include SGLT-2 inhibitors (e.g., dapagliflozin), orlistat, and pramlintide. However, orlistat does not cause glycemic control, which is desired in this patient, and pramlintide is only used in combination with insulin therapy.
Nateglinide
Nateglinide, a meglitinide, is associated with weight gain and is therefore not the most appropriate medication for this patient.
