The dose of metformin should be reviewed if the eGFR is < 45 mL/min/1.73 m2 . If the eGFR drops below 30 mL/min/1.73 m2, metformin should be stopped. According to ADA guidelines, metformin is contraindicated in patients with an eGFR < 30 mL/min/1.73 m2; eGFR rates of patients taking metformin should always be monitored. Caution should be used by persons at risk for sudden deterioration in kidney function and those at risk for eGFR falling below 45 mL/min/1.73 m2.
The National Institute for Health and Care Excellence (NICE) guidelines suggest that pioglitazone should not be offered to or continued in adults with T2D if they have:
Current, or a history of, bladder cancer
Heart failure or history of heart failure
Uninvestigated macroscopic hematuria
In adults with T2D, if initial drug treatment with metformin has not continued to control A1c to below the person's individually agreed threshold for intensification, NICE recommends considering dual therapy with:
Metformin and a DPP-4 inhibitor or
Metformin and pioglitazone or
Metformin and a sulfonylurea
In adults with T2D, if dual therapy with metformin and another oral drug has not continued to control A1c to below the person's individually agreed threshold for further intervention, NICE recommends triple therapy by adding a DPP 4 inhibitor, pioglitazone, or an SGLT2 inhibitor for patients, as appropriate.
Learn more about the treatment of T2D.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Romesh Khardori, Anne L. Peters. Fast Five Quiz: Type 2 Diabetes Key Aspects - Medscape - Dec 15, 2022.