Managing Newly Diagnosed Type 2 Diabetes Mellitus in an Obese Patient-Treatment Strategies and Patient Preferences Q1. Which classes of diabetes medications are either weight-neutral or cause weight loss? Please give one (1) example of a drug's generic and trade name in that class.

The classes of diabetes medications that are either weight neutral or cause weight loss in diabetic patients include the sodium-dependent glucose cotransporter proteins-2 (SGLT-2) inhibitors, also known as gliflozins, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors. Consistently, GLP-1 has the most impact on weight loss, followed by SGLT-2, while DPP-4 has a neutral weight loss impact on obese patients (Haddad et al., 2023). An example of a medication from the SGLT-2 class is empagliflozin, which is sold under the trade name Jardiance.

Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with, the frequency, and the route.

Based on the current ADA guidelines, the right agent for monotherapy for the patient since she is hesitant to start on insulin is Metformin. Metformin is the generic name and is sold under the trade name Glucophage. Metformin is recommended as per the ADA guidelines as the first-line medication for managing 2 diabetes (Steinberg & Carlson, 2019).   The patient will be started on Metformin 500mg, which is to be taken twice a day orally. The medication will be taken 30 minutes before the meals. Noting that the diabetic patient is obese, pre-hypertensive, and lab tests show total cholesterol is 260 mg/dL, with triglycerides at 290 mg/dL, HDL at 49 mg/dL, and LDL at 170 mg/dL, Metformin taken 30 minutes before meals is expected to manage both TC and cholesterol levels as has it has been noted to improve postprandial triglycerides and LDL-Cholesterol levels by 8%, and lower plasma glucose by 7.5% compared to if taken during meals (Methnani et al., 2023).

Q3. What are the contraindications of your selected diabetic therapy?

Metformin is contraindicated for renal impairment, leading to high serum creatine levels due to abnormal creatine clearance, congestive heart failure, especially in elderly patients, and acute or chronic metabolic acidosis (Adriana Stoica et al., 2020). Metformin is also contraindicated for reactions and conditions that increase the risk of heart failure, heart attack, and respiratory failure.

Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? 

The confirmation for hypothyroidism will be using Thyroid Stimulating Hormone (TSH) and Free thyroxine test (Free T4 test). TSH test is a blood workup that tests the levels of TSH in the blood. The Free T4 test is a blood workup to test the levels of unbound T4 hormone in the blood. Besides testing for hypothyroidism, these tests can also be used to test for hyperthyroidism. In a patient with hypothyroidism, the results for the TSH test will show elevated levels of TSH, while the test for Free T4 will show low levels of T4 below 0.4 mU/L, indicating reduced thyroid function. For a patient with hyperthyroidism, the results from the TSH test will show low levels of TSH, while the free T4 test will show elevated levels of T4 due to increased thyroid function, increasing production of thyroxine (T4) and triiodothyronine (T3).