Biguanides Metformin Case Study

A 40 year old man with a family history of DM comes to the Diabetes Clinic for the second time, three months after his first visit. At the first visit he had been diagnosed as having Type 2 DM, which had manifested after intense family problems, with typical symptoms (polyuria and polydipsia) and balanoposthi-tis. At that time the patient weighed 102 kg (224.9 lb) and had a body mass index of 33.6 kg/m2. He had an office job, sitting for long hours, and smoked roughly 30 cigarettes a day. He drank 2-3 glasses of beer 2-3 times per week. His arterial blood pressure was 140/80 mmHg, his glycosylated haemoglobin (HbA1c) 10 percent (normal values 4.8-6.2 percent) and his fasting blood glucose 200 mg/dl (11.1 mmol/L). The serum total cholesterol was 294 mg/dl (7.6 mmol/L) and the triglycerides 400 mg/dl (4.52 mmol/L). He had been recommended to follow a diet of 1,700 calories and to start exercising, as well as perform a cardiovascular system check up (exercise stress test, carotid ultrasound), 24-hour urine albumin excretion and serum TSH measurement. He was also prescribed a daily aspirin. The patient followed the diet, as well as a programme of relatively increased physical activity and lost 9 kg (19.8 lb), improving his blood examinations. During the last visit his arterial pressure was 130/80 mmHg, his fasting blood glucose 130-140 mg/dl (7.2-7.8 mmol/L), post-prandial glucose 190-210 mg/dl (10.6-11.7 mmol/L), HbA1c 8.9 percent, serum total cholesterol 212 mg/dl (5.5 mmol/L) and triglycerides 201 mg/dl (2.3 mmol/L). The 24-hour urine albumin excretion and the serum TSH were within normal range, as was a complete chemistry profile. The symptoms had completely subsided. He did not give up smoking, but slightly limited it, and he stopped drinking beer.

After a review of his diet and his general health condition, metformin was recommended at a dose of 850 mg with lunch. Furthermore, a statin was prescribed. The importance of smoking cessation was pointed out to him.

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