From the Guidelines
The regimen of Janumet XR 50-1000 mg twice daily with lunch and dinner and Jardiance 10 mg once daily with breakfast is not recommended due to the incorrect dosing schedule of Janumet XR, which could lead to excessive medication exposure and increased risk of side effects. According to the most recent guidelines, metformin is the preferred initial pharmacologic agent for type 2 diabetes, and it is typically prescribed once daily, not twice daily 1. Janumet XR, which contains metformin and sitagliptin, is also usually prescribed once daily. Taking it twice daily could potentially lead to excessive medication exposure and increased risk of side effects, such as hypoglycemia or gastrointestinal intolerance. Jardiance 10 mg daily is an appropriate standard dose, and it works by increasing glucose excretion through the kidneys. However, the incorrect dosing schedule of Janumet XR outweighs the benefits of this combination therapy. The American Diabetes Association recommends that when monotherapy with a noninsulin agent at the maximum tolerated dose does not achieve or maintain the HbA1c target over 3 months, a second agent should be added 1. In this case, the combination of Janumet XR and Jardiance may be effective, but the dosing schedule of Janumet XR needs to be adjusted to once daily to minimize the risk of adverse effects. Therefore, I would recommend consulting with the prescribing physician about the Janumet XR dosing schedule to adjust it to once daily and monitor the patient's response to the combination therapy. This approach prioritizes the patient's safety and minimizes the risk of adverse effects, while also considering the benefits of combination therapy for uncontrolled diabetes. Some key points to consider when adjusting the dosing schedule include:
- Monitoring the patient's blood glucose levels and adjusting the dose of Janumet XR as needed to achieve the target HbA1c level
- Assessing the patient's kidney function and adjusting the dose of Jardiance as needed to minimize the risk of adverse effects
- Educating the patient on the importance of adhering to the prescribed dosing schedule and monitoring their blood glucose levels regularly.
From the Research
Medication Regimen for Uncontrolled Diabetes
The given regimen consists of Janumet XR 50-1000 MG Tablet Extended Release 24 Hour 1 tab twice daily with lunch and dinner Orally Once a day, and Jardiance 10 MG Tablet 1 tablet daily with breakfast Orally Once a day.
- The medication Janumet XR contains sitagliptin, which has been shown to improve glycaemic control and β-cell function when used in combination with metformin and pioglitazone 2.
- Jardiance, containing empagliflozin, is an SGLT2 inhibitor that has been found to be effective in reducing blood glucose levels and improving cardiovascular outcomes in patients with type 2 diabetes.
- However, the provided studies do not specifically address the efficacy of this exact regimen for uncontrolled diabetes.
- According to the American Diabetes Association, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy when the A1C level is 9% or more 3.
- The treatment of type 2 diabetes mellitus involves a comprehensive approach, including lifestyle modifications, oral glycemic medications, and insulin therapy, with the goal of achieving individualized glycemic targets 4, 3, 5.
Key Considerations
- The choice of medication regimen should be based on individual patient factors, such as age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life 3.
- The treatment algorithm for type 2 diabetes mellitus has a layered approach, beginning with a combination of insulin-sensitizer therapy and incrementally progressing to triple oral therapy with the addition of secretagogues and, if necessary, the addition of subcutaneous insulin to maintain glycemic control 5.
- It is essential to monitor patients with uncontrolled diabetes closely and adjust the treatment regimen as needed to achieve optimal glycemic control and prevent complications 6, 4, 3.