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A1C Treatment Plan

Nov 25, 2017

A 54-year-old male presents to your office for an initial visit. His past medical history is significant for hypertension, hypertriglyceridemia and acute pancreatitis. His current lab results show an A1C 9.1%, which is confirmed on a repeat lab. You would like to start him on an antihyperglycemic treatment regimen. Which of the following two-drug combinations is contraindicated for this patient?


Correct Answer: D. Metformin + a GLP-1 receptor agonist

Educational Critique: Given this patient’s A1C, initiating a 2-drug combination therapy would be an appropriate choice. The incretin-based drugs (GLP-1 receptor agonist and DPP-4 inhibitors) are contraindicated if there is a history of pancreatitis as they have been linked to reports of acute pancreatitis, although their possible role increasing the risk of pancreatitis is not clear. The GLP-1 receptor agonists are glucose dependent and work at the pancreatic level to stimulate insulin secretion and suppress glucagon production. DPP-4 inhibitors inhibit DDP-4 (DDP-4 inactivates the incretins), leading to an increase in active incretin levels.