Can I continue a patient on oral diabetic medication?

From the Guidelines

Yes, you can continue a patient on oral diabetic medication, but this decision should be based on several factors including the patient's current glycemic control, kidney and liver function, medication adherence, and presence of side effects. When considering the continuation of oral diabetic medication, it is essential to assess the patient's response to the current treatment regimen, including the effectiveness of the medication in achieving and maintaining the target HbA1c level, typically <7% for most patients 1. Common oral antidiabetic medications include metformin, which is typically the first-line treatment, starting at 500mg once or twice daily, sulfonylureas like glipizide or glyburide, DPP-4 inhibitors like sitagliptin, SGLT-2 inhibitors like empagliflozin, and GLP-1 receptor agonists. Key considerations for continuing oral diabetic medication include:

• The patient's current glycemic control and whether the target HbA1c level is being achieved or maintained
• Kidney and liver function, as some medications may need to be adjusted or avoided in patients with impaired renal or hepatic function
• Medication adherence, as poor adherence can lead to inadequate glycemic control and increased risk of complications
• Presence of side effects, such as hypoglycemic episodes, gastrointestinal side effects, or signs of declining kidney function, which may necessitate medication adjustments Regular monitoring of HbA1c levels and regular follow-up appointments are crucial to evaluate treatment efficacy and make necessary adjustments to the medication regimen 1. Additionally, lifestyle modifications, including diet and exercise, should complement pharmacological treatment to achieve optimal glycemic control. For patients with cardiovascular disease or kidney disease, certain medications like SGLT-2 inhibitors or GLP-1 receptor agonists may offer additional benefits beyond glucose control, as suggested by recent guidelines 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Continuing Oral Diabetic Medication

The decision to continue a patient on oral diabetic medication depends on various factors, including the type of medication, the patient's response to treatment, and the presence of any side effects or comorbidities.

• According to a review of the efficacy and safety of oral antidiabetic drugs 2, several new oral agents have been approved for type 2 diabetes management in recent years, and it is essential to understand their efficacy and safety to maximize oral drug therapy for diabetes.
• A study on the effectiveness and safety of adding basal insulin glargine in patients with type 2 diabetes mellitus exhibiting inadequate response to metformin and DPP-4 inhibitors with or without sulfonylurea found that the combination add-on therapy was safe and efficient in reducing HbA1c levels 3.
• Another study compared the safety and efficacy of sulfonylureas and DPP-4 inhibitors as second-line therapies in type 2 diabetes mellitus, suggesting that DPP-4 inhibitors may be considered a clinically stable choice for second-line therapy after completing maximally tolerated doses of metformin 4.
• A review of oral antidiabetic agents noted that the selection of initial monotherapy is based on a clinical and biochemical assessment of the patient, with safety considerations being paramount, and that oral antidiabetic agents should be initiated at a low dose and titrated up according to glycaemic response 5.
• In patients receiving corticosteroid therapy, the management of diabetes is crucial, and oral drugs can be continued at a higher dose if the fasting serum glucose is below 2 g/L, except in cases where the underlying disease might cause acute decompensation requiring insulin 6.

Factors to Consider

When deciding whether to continue a patient on oral diabetic medication, the following factors should be considered:

• The patient's response to treatment, including any improvements or declines in glycemic control
• The presence of any side effects or adverse reactions to the medication
• The patient's overall health status, including the presence of any comorbidities or complications
• The potential benefits and risks of continuing or discontinuing the medication
• Alternative treatment options, including lifestyle modifications, other medications, or insulin therapy.