What additional therapy, if any?

From the Guidelines

Patients with confirmed office-based blood pressure ≥140/90 mmHg should have prompt initiation and timely titration of pharmacologic therapy, including ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics, or dihydropyridine calcium channel blockers, to achieve blood pressure goals 1. When considering additional therapy for patients with hypertension and diabetes, healthcare providers should:

• Evaluate the effectiveness of current lifestyle therapy and pharmacologic treatments
• Assess for any side effects or complications, such as changes in serum creatinine/estimated glomerular filtration rate and serum potassium levels 1
• Consider the patient's overall health status, comorbidities, and urinary albumin-to-creatinine ratio
• Review recent test results and disease progression
• Discuss the patient's goals and preferences Potential additional therapies could include:
• Adjusting medication dosages, such as titrating ACE inhibitors or angiotensin receptor blockers to the maximum tolerated dose
• Adding complementary medications, such as dihydropyridine calcium channel blockers or thiazide-like diuretics
• Incorporating non-pharmacological interventions, such as physical therapy or counseling, to support lifestyle modifications To determine appropriate additional therapy, a thorough clinical assessment and discussion with the patient is necessary, taking into account the latest guidelines and evidence-based recommendations 1. Any new treatments should be introduced gradually, with close monitoring for efficacy and side effects.

From the FDA Drug Label

Table 3 presents clinically significant drug interactions with metformin hydrochloride tablets.

Insulin Secretagogues or Insulin Clinical Impact:Coadministration of metformin hydrochloride tablets with an insulin secretagogue (e.g., sulfonylurea) or insulin may increase the risk of hypoglycemia.

Intervention:Patients receiving an insulin secretagogue or insulin may require lower doses of the insulin secretagogue or insulin.

Additional therapy that may be used with metformin includes:

• Insulin secretagogues (e.g., sulfonylurea)
• Insulin However, patients receiving these therapies may require lower doses of the insulin secretagogue or insulin to minimize the risk of hypoglycemia 2.

From the Research

Additional Therapy

There are limited studies that directly address additional therapy for patients with mild cognitive impairment or other conditions. However, some studies provide insight into the importance of patient-centered care and the need for personalized treatment approaches.

• The study by 3 suggests that periodically monitoring patients and providing lifestyle guidance, while also treating lifestyle-related diseases, is an appropriate treatment strategy for those with mild cognitive impairment.
• The study by 4 highlights the importance of patients' expectations in medical treatment and suggests that understanding and assessing these expectations can facilitate interventions to optimize patients' expectations and improve health outcomes.
• The study by 5 outlines a method for creating standardized generic and condition-specific patient-reported outcome measures, which can be used to inform patient care and healthcare improvement.

Patient-Centered Care

Some studies emphasize the importance of patient-centered care and patient-initiated interventions.

• The study by 6 describes a patient- and family-initiated rapid response system, which allows patients and families to activate rapid response teams and address concerns or issues with their care.
• This approach can help identify safety issues and nonsafety issues, such as inadequate pain control or dissatisfaction with staff, and can lead to changes in care.

Personalized Treatment Approaches

Overall, the studies suggest that personalized treatment approaches, which take into account patients' individual needs and expectations, are essential for providing high-quality care.

• The study by 3 notes that hurriedly notifying patients of their condition can cause worry or emotional tension, highlighting the need for cautious and personalized communication.
• The study by 4 recommends that future research should apply standardized, psychometrically evaluated measures to assess multidimensional aspects of patients' expectations, which can inform personalized treatment approaches.