From the Guidelines
No, neither medication should be discontinued at this time, as the current regimen is providing reasonable glycemic control with a fasting glucose of 110 mg/dL, which is at the upper limit of normal but not yet in the diabetic range. The patient is on Mojarro (likely a misspelling of Mounjaro, a GLP-1/GIP receptor agonist) once a week and metformin 1000 mg twice a day, which work synergistically through different mechanisms to improve insulin secretion and reduce glucagon, and decrease hepatic glucose production and improve insulin sensitivity, respectively 1. According to the 2024 standards of care in diabetes, metformin may be particularly beneficial for individuals with a higher baseline fasting glucose, such as this patient, as it has been shown to provide higher risk reductions in diabetes risk in such subgroups 1.
Key points to consider in this patient's management include:
- Monitoring for hypoglycemia, especially if fasting glucose levels decrease further
- Regular HbA1c testing (every 3-6 months) to assess long-term glycemic control
- Periodic assessment of vitamin B12 level in metformin-treated individuals, especially in those with anemia or peripheral neuropathy, as metformin may be associated with vitamin B12 deficiency 1
- Any medication adjustments should be based on trends in glucose readings and HbA1c values rather than a single fasting glucose measurement.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
The recommended starting dose of metformin hydrochloride tablets are 500 mg orally twice a day or 850 mg once a day, given with meals.
7 DRUG INTERACTIONS
Table 3 presents clinically significant drug interactions with metformin hydrochloride tablets.
The patient is already on metformin 1000 mg twice a day, and the fasting glucose is 110. No information is provided about the Mojarro.
- The metformin dose is within the recommended range.
- There is no direct information to suggest that any medication should be discontinued based on the provided fasting glucose level.
- No conclusion can be drawn about the Mojarro, as there is no information provided about this medication in the context of the patient's current treatment and glucose level 2, 2, 2.
From the Research
Patient's Current Treatment and Condition
- The patient is currently taking Mojarro once a week and metformin 1000 mg twice a day.
- The patient's fasting glucose level is 110.
Considerations for Discontinuing Treatment
- According to the study 3, GLP-1 receptor agonists, such as Mojarro, have been shown to be effective in reducing HbA1c levels and body weight in patients with type 2 diabetes.
- The study 4 found that the combination of premixed insulin, metformin, and a GLP-1 receptor agonist improved glycemic control in patients with uncontrolled type 2 diabetes.
- However, the study 5 suggested that the glucose-lowering effect of metformin is not mediated by GLP-1 receptor agonism.
- The study 6 found that GLP-1 receptor agonists may reduce or delay the need for further treatment intensification compared to other standard glucose-lowering therapies.
- The study 7 compared the efficacy and safety of GLP-1 receptor agonists with sodium-glucose cotransporter 2 inhibitors for obese type 2 diabetes patients uncontrolled on metformin, and found that GLP-1 receptor agonists achieved significant reductions in HbA1c, fasting blood glucose, and postprandial blood glucose.
Decision to Discontinue Treatment
- Based on the available evidence, it is not clear whether the patient's current treatment should be discontinued.
- The patient's fasting glucose level of 110 is not excessively high, and the combination of Mojarro and metformin may still be effective in controlling their blood glucose levels.
- However, the patient's treatment plan should be regularly monitored and adjusted as necessary to ensure optimal glycemic control and minimize potential side effects.