Stop or Switch the Antidiabetic Drug?

Charles P. Vega, MD


August 14, 2019

Welcome to Cases in Deprescribing. In this series, I present a common clinical scenario drawn from my own practice, and hopefully familiar to virtually all of our readers. I will share my plan with you, but I am more interested in crowdsourcing a response from all of you to collectively determine best practice.

Please answer the polling question and contribute to the comments section with your own thoughts, particularly if you disagree with me.

Elderly Woman on Antidiabetic Therapy

You are seeing an 85-year-old woman for a routine follow-up visit. Her diagnoses include type 2 diabetes, chronic kidney disease stage III with a steady estimated glomerular filtration rate (eGFR) of 50 mL/min, and coronary heart disease (coronary stents placed 6 years ago). She lives with her daughter but is mostly independent. She dislikes home glucose testing and performs it only a few times per month ("I can't stand those little needles!"). Her morning glucose levels are between 130 and 160 mg/dL. She has about two mild hypoglycemic episodes per month that resolve with a snack.

She is a nonsmoker and does little to control her diet, although her portion sizes are generally small. She does not exercise. She has seen a diabetes counselor who provided advice and encouragement on lifestyle. Her current medication regimen includes:

Her body mass index is 30 kg/m2, and her physical examination is normal for an older, obese woman. Recent laboratory work included an A1c level of 7.5%. Other results were within normal limits for age except for her low eGFR and a slightly elevated serum creatinine


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