What are pertinent questions for Medication Therapy Management (MTM) for a diabetic patient taking metformin (biguanide) and injecting Lantus (insulin glargine)?

Pertinent Questions for MTM in Diabetic Patients on Metformin and Lantus

The most pertinent questions for Medication Therapy Management (MTM) in diabetic patients taking metformin and injecting Lantus (insulin glargine) should focus on glycemic control, medication adherence, proper administration techniques, and monitoring for adverse effects to reduce morbidity and mortality.

Glycemic Control Assessment

• What are your most recent HbA1c values and when was it last checked? (Target typically individualized, but generally <7% for most adults) 1
• What are your typical fasting blood glucose readings? (Target 4.0-5.5 mmol/L or 70-100 mg/dL) 1
• Do you experience any symptoms of hyperglycemia (excessive thirst, frequent urination, blurry vision, fatigue)?
• How often do you check your blood glucose levels? What patterns have you noticed?
• Do you keep a log of your blood glucose readings?

Metformin-Specific Questions

• What dose of metformin are you currently taking? (Typical effective dose range is 2000-2500 mg daily in divided doses) 2
• Do you take metformin with meals to minimize gastrointestinal side effects? 1
• Have you experienced any gastrointestinal side effects such as diarrhea, nausea, abdominal discomfort, or loss of appetite? 3
• Have you had your kidney function checked recently? (Metformin requires dose adjustment with declining renal function) 1
• Are you taking the immediate-release or extended-release formulation? (Extended-release may improve GI tolerability) 3

Insulin Glargine (Lantus) Administration

• What is your current Lantus dose and when do you inject it? (Should be taken at the same time every day) 4
• Do you know how to self-adjust your insulin dose based on your blood glucose readings? 1
• How do you store your insulin? (Should be stored properly to maintain potency) 1
• Do you rotate your injection sites? (Important to prevent lipodystrophy) 4
• Have you noticed any lumps, pits, or thickening at your injection sites? 4
• Do you reuse needles? (Should always use a new needle for each injection) 4

Hypoglycemia Assessment

• Do you experience symptoms of hypoglycemia (shakiness, sweating, confusion, headache, dizziness)? 4
• How often do you experience hypoglycemia and at what times of day?
• Do you know how to recognize and treat hypoglycemia? 1
• Do you carry fast-acting carbohydrates with you to treat hypoglycemia?
• Has anyone ever had to assist you during a hypoglycemic episode?

Lifestyle and Self-Management

• What is your typical daily meal pattern and carbohydrate intake?
• Do you engage in regular physical activity? What type and how often? (Recommendation: at least 150 minutes/week of moderate-intensity aerobic activity) 2
• Have you had any recent changes in weight? 1
• Do you adjust your insulin dose before exercise or when your meal pattern changes? 1
• Do you have "sick day" rules for managing your diabetes during illness? 1

Medication Adherence

• Do you ever miss doses of metformin? If so, how often and why?
• Do you ever miss doses of Lantus? If so, how often and why?
• Do you have any difficulties affording your medications?
• Are you using any other medications, supplements, or herbal products?
• Have you experienced any barriers to taking your medications as prescribed?

Monitoring and Follow-up

• When was your last comprehensive diabetes check-up?
• Have you had recent laboratory tests for kidney function, lipid profile, and liver function?
• When was your last eye examination and foot examination?
• Do you have a primary care provider or endocrinologist managing your diabetes?
• Do you have any upcoming appointments scheduled?

Common Pitfalls to Address

• Failure to recognize the importance of consistent timing with Lantus administration 4
• Not understanding how to properly adjust insulin doses based on glucose readings 1
• Stopping metformin due to GI side effects without trying extended-release formulations or proper titration 3
• Not recognizing or properly treating hypoglycemia 4
• Poor injection technique leading to variable insulin absorption 1
• Not understanding the complementary roles of metformin (primarily affecting hepatic glucose output) and basal insulin (controlling fasting glucose) 5

By addressing these key areas during MTM, pharmacists can help optimize medication therapy, improve glycemic control, and reduce the risk of diabetes-related complications in patients taking metformin and Lantus.