Endocrine Abstracts

1. 58 year old man – Mr CB

2. Type 2 diabetes for 16 years

3. Well controlled hypertension

4. Microalbuminuria with ACR 19

5. Persistent haematuria with stone disease

6. No retinopathy or neuropathy

7. No macrovascular disease

8. Otherwise fit and well

9. Obese with BMI 33, not responsive to dietary modification

10. Dyslipidaemic with Cholesterol 6.4, Trigs 5.9

11. On Metformin 1 g tds, Lisinopril 2.5 mg od, Bezafibrate MR 400 mg od, Aspirin 75 mg od

12. Persistently high HbA1cs of around 10%

13. Initiated on Rosiglitazone 4 mg od

14. Weight unchanged

15. Continued sub optimal control after 6 months but slight improvement in HbA1c to 9.3%

16. Would you initiate insulin treatment at this stage; increase Rosiglitazone to 8 mg od or add a sulphonylurea?

17. Trial of Gliclazide 80 mg od

18. Also changed fibrate to Simvastatin 40 mg on

19. HbA1c improved to 7.3%

20. Persistently reasonable

21. Last HbA1c 6.5%

22. Cholesterol 4.2, HDL 0.9, Trigs 2.1

23. A vindication for the unlicensed triple oral therapy approach?

58 year old man – Mr CB

Type 2 diabetes for 16 years

Well controlled hypertension

Microalbuminuria with ACR 19

Persistent haematuria with stone disease

No retinopathy or neuropathy

No macrovascular disease

Otherwise fit and well

Obese with BMI 33, not responsive to dietary modification

Dyslipidaemic with Cholesterol 6.4, Trigs 5.9

On Metformin 1 g tds, Lisinopril 2.5 mg od, Bezafibrate MR 400 mg od, Aspirin 75 mg od

Persistently high HbA1cs of around 10%

Initiated on Rosiglitazone 4 mg od

Weight unchanged

Continued sub optimal control after 6 months but slight improvement in HbA1c to 9.3%

Would you initiate insulin treatment at this stage; increase Rosiglitazone to 8 mg od or add a sulphonylurea?

Trial of Gliclazide 80 mg od

Also changed fibrate to Simvastatin 40 mg on

HbA1c improved to 7.3%

Persistently reasonable

Last HbA1c 6.5%

Cholesterol 4.2, HDL 0.9, Trigs 2.1

A vindication for the unlicensed triple oral therapy approach?