Real World Case Series Issue 2

Clinical Case Brief

70 Year old Male

Social History :

• Addicted to Tobacco and following sedentary Lifestyle

Family History :

• Mother had T2DM

Physical Examination :

• BP: 120/70 mmHg
• Pulse: 104 beats/min
• Height: 157 cm
• Body Weight: 72.7 Kg

Laboratory Investigations before 13th Dec, 2023                                      

• HbA1c: 7.3%
• FBG: 242 mg/dl
• PPG: 328 mg/dl
• Creatinine: 1.52 mg/dl

Medical History :

• T2DM from last 8 years
• Hypothyroidism from last 14 years Also Diagnosed with following on 3rd  Nov’ 23
• Dyslipidemia, Chronic Pancreatic Disease, Diabetic Kidney Disease
• Heart Disease
• Had undergone Cholecystectomy

Medication History :

• Metformin- 1000 mg OD
• Empagliflozin-25 mg OD
• Glimepiride-4 mg OD
• Thyroxine - 75 µg OD
• Rosuvastatin- 10 mg OD
• Etizolam-0.5 mg OD
• Torsemide- 5mg OD
• Silodosin + Dutasteride (8+0.5) mg OD

Patient Diagnosis: Uncontrolled Hyperglycemia

Expert's Concern :

• Patient with Uncontrolled Hyperglycemia especially HbA1c and fasting plasma Glucose in the background of Chronic pancreatic disease

Revised Treatment on 13th Dec’ 2023 with Addition of Imeglimin: 1000 mg B.D.

Replaced Medication

• Empagliflozin and Glimepiride

Post Follow up Changes in Medication :

• Imeglimin: 1000 mg B.D
• Metformin- 500 mg B.D
• Gliclazide-60 mg BD
• Pioglitazone- 15 mg BD

Key Findings after using Imeglimin

• HbA1c: 8.6 %
• FBG: 172 mg/dl
• PPG: 71 mg/dl

Major Highlights of the Case    

Changes Done in Medication :

• Replacement of Empagliflozin and Glimepiride with Addition of Imeglimin and Gliclazide Reduced the dose of Pioglitazone from 30mg to 15mg

Follow up Advice :

• Imeglimin: 1000mg B.D continue for next 3 months

Experts’ View :

• The Fasting Plasma Glucose at baseline 242 mg/dl is reduced to 172 mg/ dl
• Post prandial plasma glucose at baseline 328 is reduced to 71 mg/dl in 2 months
• The result of HbA1c will be followed after 3 months in periodic Check up

Benefits to patient :

• No Adverse effect
• No Hypoglycemia