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Antihyperglycemic Regimen

Jan 6, 2018

A 75-year-old man presents to your office with complaints of occasional mild hypoglycemia. His current antihyperglycemic regimen includes metformin and nateglinide. You would like to modify his treatment regimen to minimize his risk of hypoglycemia. Which one of the following 2-drug combinations would NOT be a suitable substitution?


Answer: B. Metformin + glipizide

Educational Critique: In this case, the sulfonylureas (glipizide) and meglintinides (nateglinide) can lead to hypoglycemia (meglinitides less so than sulfonylureas). The thiazolidinediones (pioglitazone), DPP-4 inhibitors (vildaglipitin), GLP-1 agonists (exenatide), and metformin have low hypoglycemic potential as a side effect. The thiazolidinediones (pioglitazone), DPP-4 inhibitors (vildaglipitin), and GLP-1 agonists (exenatide) can be used in various combinations with metformin to provide glycemic control when the goal is to minimize hypoglycemia.