Real World Case Series Issue 3

Clinical Case Brief

50 year old Male

Businessman

Social History :

Addicted to Tobacco and following sedentary Lifestyle

Family History :

• Mother had T2DM

Physical Examination :

• BP: 140/90 mmHg
• Height: 170 cm
• Body Weight: 79.5 Kg

Laboratory Investigations before 9th Feb' 2024

• HbA1c: 9.2%
• FBG: 196 mg/dl
• PPG: 260 mg/dl

Medical History :

• T2DM and HTN from last 12 years
• Proliferative Diabetic Retinopathy with Vitreous Hemorrhage
• Had undergone Right eye Vitrectomy

Medication History :

• Metformin 1500 mg OD
• Dapagliflozin-10 mg OD
• Sitagliptin 100 mg OD
• Glimepiride 4 mg OD 
• Pioglitazone 15 mg OD
• Voglibose - 0.2 mg BD
• Ryzodeg 12units OD 
• Telmisartan 40 mg OD
• Rosuvastatin 10 mg Fenofibrate 160 mg OD

Expert's Concern

Patient with Uncontrolled Hyperglycemia especially HbA1c and fasting plasma Glucose in the background of Prolific Diabetic Retinopathy with Vitreous Hemorrhage

Revised Treatment on 9th Feb' 2024 with Addition of Imeglimin: 1000 mg B.D.

Replaced Medication

• Stopped Insulin. Ryzodeg 
• Stopped Dapagliflozin

Post Follow up Changes in Medication :

• Metformin- 1500 mg OD 
• Imeglimın 1000 mg BD
• Sitagliptin-100 mg OD
• Glimepiride 4mg OD
• Pioglitazone 15 mg OD
• Voglibose-0.2 mg BD

Key Findings after 3 months of Imeglimin

• HbAlc: 7.5%
• FBG: 135 mg/dl
• PPG: 180 mg/dl

Major Highlights of the Case

Changes Done in Medication :

• Dapagliflozin stopped due to UTI
• Stopped Ryzodeg with addition of Imeglimin 1000mg B.D

Follow up Advice :

Imeglimin 1000 mg B.D. should be continued for a longer period of time

Experts' View:

• 1. The HbA1c is reduced by 1.7%
• 2. Safe on patients with Retinopathy
• 3. No need of frequent monitoring of RBS

Benefits to patient :

• No Adverse effect
• No Hypoglycemia
• No U.T.I