Deintensifying Diabetes Drugs: Important Considerations

Jay H. Shubrook, DO; Jaron C. West, MSPAS, MPH


February 19, 2019

This transcript has been edited for clarity.

Jay H. Shubrook, DO

Jay H. Shubrook, DO: Welcome back to Everyday Diabetes: Practical Pointers for Primary Care. I'm Jay Shubrook, family physician and diabetologist at Touro University, California. We hear a lot about the importance of intensifying insulin therapy in our patients with type 2 diabetes. And that is reasonable; it is important to get people to goal. A corollary that is becoming very important is: When do we deintensify insulin? When do we step back?

To discuss this, I am delighted to have with me Jaron West, a physician assistant who holds a masters of public health. He works at the Solano County Family Health Services, a series of Federally Qualified Health Centers providing care in northern California. Jaron, thanks for joining me today.

Jaron C. West, MSPAS, MPH

Jaron C. West, MSPAS, MPH: Thanks for having me.

Shubrook: I want to share a case with you. Rhonda is a 64-year-old woman who presents today for a diabetes recheck. She was first diagnosed with type 2 diabetes about 18 years. She currently is taking metformin 1000 mg twice a day, glipizide 10 mg twice a day, and glargine 16 units one time a day.

Her recent A1c has climbed to 7.8%. As much as I've encouraged her to check her blood sugar levels, she doesn't check that often. She does report at least one symptomatic hypoglycemic episode every week. This is the thing that scares her a little bit.

Her medical history is complicated. She had a myocardial infarction about 5 years ago. She now has congestive heart failure with an estimated ejection fraction of about 30%. Her recent labs suggest worsening chronic kidney disease (CKD), as her estimated glomerular filtration rate (eGFR) is now about 40 mL/min/1.73 m2.

My first question would be, what is your A1c goal for her?


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