Selecting the most appropriate anti-diabetic medication can be challenging. There are many patient specific factors to consider. The following set of questions will highlight some of the factors to consider when selecting drug treatment.
1 – Sally is a 35- year old female with type 2 diabetes, currently treated with Lantus 40 units SC every night and Humalog 12 units SC TID before meals. Due to the high cost of insulin, she wants to switch to an oral medication and prefers an agent that would not cause weight gain. Which of the following agents would you recommend?
A – Pioglitazone 15 mg daily
B – Glipizide 5 mg daily
C – Exenatide 5 mg BID
D – Canagliflozin 100 mg daily
E – Repaglinide 1 mg TID
2 – Mike is a 50 year old male with PMH: DM, HTN, CHF and obesity (BMI 50). For his Diabetes treatment, he is currently on Metformin 1000 mg BID. His most recent A1C is 10.4%. The physician would like your recommendation for an add on therapy to better control Mike’s blood glucose. Which of the following oral agents would you recommend?
A – Saxagliptin
B – Pioglitazone
C – Liragluride
D – Glipizide
E – Canagliflozin
- Ryan is a 58 year old male with PMH notable for HTN, hyperlipidemia, pancreatitis and bilateral knee osteoporosis. He is newly diagnosed with type 2 diabetes. Given his comorbidities, which of the following medications is the most appropriate agent to start at this time?
A – Actos
B – Invokana
C – Glucotrol
D – Januvia
E – Trulicity
- Malika is a 38 year old female with newly diagnosed type 2 diabetes. She has agreed to using an injectable as long as it’s dosed weekly. Which of the following medications do you recommend?
A – Victoza
B – Trulicity
C – Byetta
D – Adlyxin
E – None of the above
- Mary is a 40 year old female with poorly controlled type 2 diabetes. She is currently taking Metformin 1000mg BID and the physician would like to add another agent to better control her blood glucose. She has recurrent UTIs and is otherwise healthy. Which of the following medications should be avoided in Mary?
A – Glipizide
B – Empagliflozin
C – Pioglitazone
D – Linagliptin
E – Semaglutide
- Jake is a 50 year old man with type 2 diabetes currently on Metformin alone. His most recent A1C is 10.2%. He does not like taking too many medications but has agreed to taking another oral medication to better control his blood glucose. He has a history of bladder cancer. Which of the following is not an appropriate add on therapy for Jake?
A – Linagliptin
B – Canagliflozin
C – Glipizide
D – Pioglitazone
E – All are appropriate options
- Lina is a 47 year old female with newly diagnosed type 2 diabetes with PMH notable for Hypertension, Depression and history of Myocardial infarction. You are asked to recommend an agent that may help reduce cardiovascular mortality in patients with type 2 diabetes. Which of the following do you recommend?
A – Canagliflozin
B – Repaglinide
C – Glipizide
D – Insulin
E – Metformin
- Matt is a 57 year old male with newly diagnosed type 2 diabetes. He has heard that many of the medications used to treat diabetes may increase his weight. Given Matt’s concern, which of the following agents would you recommend?
A – Glipizide
B – Pioglitazone
C – Linagliptin
D – Repaglinide
E – Insulin
- Ruth is a 75 year old female with type 2 diabetes, depression, hypertension and heart failure. For her diabetes treatment she is currently taking Sitagliptin 100 mg daily, Metformin 100 mg BID, and Canagliflozin 100 mg daily. At her current clinic visit, she complains of dry mouth, increased thirst and having to urinate alot. Which of the following medications could be causing these symptoms?
A – Sitagliptin
B – Canagliflozin
C – Metformin
D – Repaglinide
E – None of the above
- Dennis is a 55 year old male with newly diagnosed diabetes. His PMH is notable for CKD with the most recent CrCl of 25ml/min. To treat his diabetes, which of the following medications is safe to initiate at this time?
A – Canagliflozin
B – Metformin
C – Glyburide
D – Liraglutide
E – None of the above
Answer Key
1 – Sally is a 35- year old female with type 2 diabetes, currently treated with Lantus 40 units SC every night and Humalog 12 units SC TID before meals. Due to the high cost of insulin, she wants to switch to an oral medication and prefers an agent that would not cause weight gain. Which of the following agents would you recommend?
A – Pioglitazone 15 mg daily – causes weight gain
B – Glipizide 5 mg daily – causes weight gain
C – Exenatide 5mg BID – injectable, question asked for an oral agent
D – Canagliflozin 100 mg daily
E – Repaglinide 1 mg TID – causes weight gain
2 – Mike is a 50 year old male with PMH: DM, HTN, HF NYHA Class III, and obesity (BMI 50). For his Diabetes treatment He is currently on Metformin 1000 mg BID. His most recent A1C is 10.4%. The physician would like your recommendation for an add on therapy to better control Mike’s blood glucose. Which of the following oral agents would you recommend?
A – Saxagliptin – may cause heart failure, patient has history of heart failure
B – Pioglitazone – contraindicated in patients with heart failure
C – Liragluride – injectable, question asked for an oral agent
D – Glipizide – causes weight gain, patient is obese
E – Empagliflozin
3 – Ryan is a 58 year old male with PMH notable for HTN, hyperlipidemia, pancreatitis, bilateral knee osteoporosis. He is newly diagnosed with type 2 diabetes. Given his comorbidities, which of the following medications is the most appropriate agent to start at this time?
A – Actos – pioglitazone increases risk of fractures, patient has osteoporosis
B – Invokana – Canagliflozin increases risk of fractures, patient has osteoporosis
C – Glucotrol
D – Januvia- Sitagliptin may cause acute pancreatitis, patient has a history of pancreatitis
E – Trulicity – Dulaglutide a warning of pancreatitis, patient has history of pancreatitis
4 – Malika is a 38 year old female with newly diagnosed type 2 diabetes. She has agreed to using an injectable as long as it’s dosed weekly. Which of the following medications do you recommend?
A – Victoza- Dosed daily
B – Trulicity
C – Byetta – Dosed twice daily, the extended release version (Bydureon) is dosed weekly
D – Adlyxin – dosed daily
E – None of the above
5 – Mary is a 40 year old female with poorly controlled type 2 diabetes. She is currently taking Metformin 1000mg BID and the physician would like to add another agent to better control her blood glucose. She has recurrent UTIs and is otherwise healthy. Which of the following medications should be avoided in Mary?
A – Glipizide
B – Empagliflozin – SGLT-2 inhibitors are associated with UTIs and genital fungal infections
C – Pioglitazone
D – Linagliptin
E – Semaglutide
6 – Jake is a 50 year old man with type 2 diabetes currently on Metformin alone. His most recent A1C is 10.2%. He does not like taking too many medications but has agreed to taking another oral medication to better control his blood glucose. He has a history of bladder cancer. Which of the following is not an appropriate add on therapy for Jake?
A – Linagliptin
B – Canagliflozin
C – Glipizide
D – Pioglitazone – associated with urinary bladder tumors; should not be used in patients with history of bladder cancer
E – All are appropriate options
7 – Lina is a 47 year old female with newly diagnosed type 2 diabetes with PMH notable for Hypertension, Depression and history of Myocardial infarction. You are asked to recommend an agent that may help reduce cardiovascular mortality in patients with type 2 diabetes. Which of the following do you recommend?
A – Canagliflozin – Canagliflozin and Empagliflozin are associated with cardiovascular benefit
B – Repaglinide
C – Glipizide
D – Insulin
E – Metformin
8 – Matt is a 57 year old male with newly diagnosed type 2 diabetes. He has heard that many of the medications used to treat diabetes may increase his weight. Given Matt’s concern, which of the following agents would you recommend?
A – Glipizide
B – Pioglitazone
C – Linagliptin – DPP4 Inhibitors are weight neutral drugs
D – Repaglinide
E – Insulin
9 – Ruth is a 75 year old female with type 2 diabetes, depression, hypertension and heart failure. For her diabetes treatment she is currently taking Sitagliptin 100 mg daily, Metformin 100 mg BID, and Canagliflozin 100 mg daily. At her current clinic visit, she complains of dry mouth, increased thirst and having to urinate alot. Which of the following medications could be causing these symptoms?
A – Sitagliptin
B – Canagliflozin – SGLT2 inhibitors cause increased urination and dehydration
C – Metformin
D – Repaglinide
E – None of the above
10 – Dennis is a 55 year old male with newly diagnosed diabetes. His PMH is notable for CKD with the most recent eGFR of 25ml/min. To treat his diabetes, which of the following medications is safe to initiate at this time?
A – Canagliflozin – SGLT2 inhibitors are contraindicated in patients with eGFR <30ml/min
B – Metformin – contraindicated in patients with eGFR <30ml/min
C – Glyburide – should be avoided in patients with renal insufficiency
D – Liraglutide
E – None of the above
