Care of patients with diabetes

Often we see a great deal of misinformation in the care of patients with diabetes, and often this misinformation is centered around the role and choice of medications. Many patients, especially newly diagnosed patients, are prescribed medications that do not fit into the scheme of the ADA / AACE guidelines / best evidence based practices – for instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin) or Byetta (exenatide) as initial monotherapy without a compelling indication or reason.

In this discussion, please talk about how patients get put on these medications and why/how they should be transitioned to more .

• Is it okay to start a patient on a drug (particularly an oral drug) other than metformin as an initial drug? Please where this could be reasonable.
• What anti-diabetic medications have compelling evidence for use in select populations, possibly as initial therapy, and is this benefit a “class” effect?
  • (eg. SGLT2Is – Patients with type 2 diabetes and a high risk ofcardiovascular diseasehad reduced risk of a cardiovascular death, nonfatalmyocardial infarction, or to those randomized to receive placebo)
• How can patients and practitioners be convinced to change their behavior and opt for more to therapy?

Now lets consider the following case about thyroid disorders.A to his family doctor because he has been feeling fatigued and lethargic. His doctor does a complete evaluation. This patient had a myocardial infarction and has a recurrent ventricular arrhythmia (treated with amiodarone). The patients TSH is elevated and his T4is slightly decreased.

• Please provide an evaluation of this patients condition, approach to therapy and factors you have taken into consideration

A minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required