Real World Case Series Issue 4

Clinical Case Brief

40 Year old Male

Businessman

Social History :

• Addicted to Tobacco and following sedentary Lifestyle

Family History : 

• Mother had T2DM

Physical Examination :

• BP: 130/80 mmHg
• Height: 168 cm
• Body Weight: 87.1 Kg

Laboratory Investigations before 14th Feb' 2024

• HbA1c: 8.5%
• FBG: 174 mg/dl
• PPG: 252 mg/dl

Medical History :

• T2DM from last 8 years
• Dyslipidemia from last 10 years
• Obesity is a major challenge for the patient

Medication History :

• Metformin Dose: 1000 mg OD
• Dapagliflozin Dose: 10 mg OD
• Sitagliptin Dose: 100 mg OD
• Glimepiride Dose: 4 mg OD
• Voglibose Dose: 0.2 mg BID
• Aspirin Dose: 75 mg OD
• Atorvastatin Dose: 10 mg OD

Expert's Concern

• Patient with Uncontrolled Hyperglycemia especially HbA1c, fasting plasma and postprandial glucose level with Dyslipidemia and Obesity.
• On top of that patient is not willing to start insulin

Revised Treatment on 14th Feb' 2024 with Addition of Imeglimin: 1000 mg B.D.

Patient Complain

• Not Interested to start Insulin, even with below conditions:
• Uncontrolled Hyperglycemia
• Dyslipidemia
• Obesity

Post Follow up Changes in Medication :

• Imeglimin Dose: 1000 mg BD
• Metformin Dose: 1000 mg OD
• Dapagliflozin Dose: 10mg OD
• Sitagliptin Dose: 100 mg OD
• Glimepiride Dose: 4 mg OD
• Voglibose Dose: 0.2 mg BID
• Aspirin Dose: 75 mg OD
• Atorvastatin Dose: 10 mg OD

Key Findings after using Imeglimin for 3 months

• HbA1c: 7.1%
• FBG: 125 mg/dl
• PPG: 164 mg/dl

Major Highlights of the Case

• Avoided Insulin due to the addition of Imeglimin

Follow up Advice :

• Imeglimin: 1000mg B.D continue for at least 1 year

Experts' View:

1. The Fasting Plasma Glucose at baseline 174 mg/dl is reduced to 125 mg/dl
2. Post prandial plasma glucose at baseline 252 mg/dl is reduced to 164 mg/dl
3. The HbA1c is reduced from 8.5% to 7.1%

Benefits to patient :

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