From the Guidelines
The patient should be transitioned to a GLP-1 receptor agonist, such as semaglutide, as an alternative to Jardiance due to its efficacy in managing diabetes and lower risk of yeast infections, as evidenced by recent studies 1. Given the patient's contraindication to metformin due to low GFR, it is crucial to consider alternative medications that are safe and effective in patients with reduced renal function.
- The patient's history of recurrent yeast infections while on Jardiance (empagliflozin) suggests that an SGLT2 inhibitor may not be the best choice for long-term management.
- GLP-1 receptor agonists, such as semaglutide, have been shown to be effective in managing diabetes and have a lower risk of yeast infections compared to SGLT2 inhibitors 1.
- DPP-4 inhibitors, like sitagliptin, may also be considered as an alternative, but dose adjustment for renal function is necessary.
- The patient should continue to follow a diabetic diet, focusing on low glycemic index foods, portion control, and limited refined carbohydrates, as this will help manage their condition and reduce the risk of complications.
- Regular blood glucose monitoring is essential during this medication transition to assess the effectiveness of the new treatment approach and monitor renal function.
- Close follow-up within 2-4 weeks is recommended to evaluate the patient's response to the new medication and make any necessary adjustments to their treatment plan.
From the Research
Patient Education and Treatment
- The patient has been educated on diet choices due to the contraindication of metformin at this time, given the patient's GFR 2.
- Jardiance has been stopped due to recurrent yeast infections, which is a known side effect of SGLT2 inhibitors, as they increase urinary glucose excretion, potentially leading to vaginal Candida colonization 2.
- The patient's history of present illness (HPI) has been written, taking into account the patient's type 2 diabetes mellitus and the need for alternative treatments.
Alternative Treatment Options
- Sitagliptin, a dipeptidyl peptidase-4 inhibitor, may be considered as an alternative treatment option for the patient's type 2 diabetes, as it has been shown to be effective in improving glycemic control with a relatively low risk of adverse events 3.
- Topical treatments, such as clotrimazole, miconazole, terconazole, and intravaginal boric acid, may be recommended for the patient's recurrent vulvovaginal candidiasis, with maintenance dosing starting at one to three times weekly 4.
Management of Candidiasis
- Candidiasis can be caused by various Candida species, with C. albicans being the most common, and can be present as a cutaneous, mucosal, or deep-seated organ infection 5.
- The global guideline for the diagnosis and management of candidiasis recommends updated treatments and management strategies, including the use of antifungals that target different biosynthetic pathways of the pathogen 6.