Lena D - DM

An appropriate prescription for Lena is:

Name: Lena Dziedzic 

Date Of Birth: 1/31/1977

Date Prescribed: Current Date

Rx: metformin (Glucophage) 500mg 

Disp: 60

Sig: Take one tablet by mouth twice daily with meals (once in the morning and once in the evening) 

Refills (O-4): 2

Dispense as Written: 

Generic Substitution Permitted: 

· Either  Dispense as Written or  Generic Substitution Permitted should be checked on every written prescription depending on what is best for each client.  Refer to the week 1 lesson for criteria.

Rationale: Biguanides like metformin are the first-line medications used to treat clients newly diagnosed with type 2 diabetes. Since this client is newly diagnosed with type 2 diabetes and does not have any contraindications, it is the appropriate medication therapy choice to add to lifestyle modifications (Samson et al., 2023). Four refills are prescribed as follow-up lab work should be done in approximately three months to recheck hemoglobin A1c. This will help the provider determine if current therapy is effective. The client should be taught to call the provider if they are experiencing any adverse effects in the interim period. Since this client is obese, if the client’s hemoglobin A1c is still elevated at a follow-up appointment, the provider should consider adding a GLP-1 agonist or an SGLT-2 inhibitor, according to the CPG (Samson et al., 2023).

Clinical Practice Guidelines for Type 2 Diabetes Management 

Prescribing considerations outlined in clinical practice guidelines (CPGs) for type 2 diabetes focus on a client-centered approach, with the choice of therapy tailored based on individual characteristics such as cardiovascular risk, kidney function, risk of hypoglycemia, and need for weight management. Initially, lifestyle modifications alongside metformin are recommended as foundational treatments. For clients with established atherosclerotic cardiovascular disease (ASCVD), heart failure, stroke/TIA, or chronic kidney disease, specific glucose-lowering medications with proven cardiovascular benefit, such as SGLT-2 inhibitors or GLP-1 receptor agonists, are preferred as first-line treatments over others due to their benefits beyond glycemic control. DPP-4 inhibitors, thiazolidinediones, and sulfonylureas are considered for clients without certain comorbidities in scenarios where first-line agents are contraindicated, not tolerated, or insufficient to achieve glycemic targets. Insulin therapy is reserved for clients with type 2 diabetes with significant hyperglycemia at diagnosis or those who do not achieve glycemic targets despite optimal use of oral agents. It is critical for providers to partner with clients for ongoing monitoring and medication regimen adjustments to achieve and maintain glycemic targets (Samson et al., 2023).