February 2020

Reviews & Perspectives with Dr. Hobart Lee: Second Line Therapies for Type 2 DM

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No me gusta!

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Ian L. -

The FDA has approved the first oral GLP-1 semaglutide realising the injections can be a trouble though you can get once a week injections administered .
With the SGLT -2 inhibitors the patient needs warning re urinary tract infections so those patients with renal tract abnormality or BPH would struggle .
In hot weather due to diuresis with SGLT-2 5 fold greater than and placebo dose would need reduction .
Mycotic infection is higher placebo % 1.63 Canaglifozin 100 mg 6.17% Jakher H et al Diabetes Metab Syndrome Obesity Feb 2019
Prudent to Exclude in patients with a foot ulcer .which is at 2-5 % .

Brendan W. -

I'm still putting brakes on SGLT2's. There are organizations interested in lawsuits regarding the amputation risk and Fournier's gangrene. At the least, I'd make sure of very good leg circulation, adequate baseline water intake and avoid use in any obese patients (GU infection risk) and those with history of UTI, and stop taking if there is nausea/not able to eat, and if there is skin breakdown.

Another option: Glimepiride
Nice review:

A balanced very low carbohydrate diet is gaining traction as well.

Heidi J., MD -

Thanks for the info. That Fournier's gangrene sure does put a damper on my enthusiasm as well. Also, I've had patients do remarkably well on a very low carb diet - impressive results. Interesting option for sure!

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