Metformin As Pharmacotherapy For Type 2 Diabetes

45 years old in respite care has cellulitis in her left leg and has prediabetes- non managed with lifestyle modifications. Overweight BMI- 30.6. Is at high risk for cardiovascular disorder- patient already on amlodipine 10mg once a day for hypertension Recent blood tests shows she has diabetes (HbA1c- 63) and is started on metformin 500mg twice a day

As a prescriber provide a pharmacotherapy plan supporting the choice and need to prescribe a metformin and discuss the pharmacotherapeutic considerations in relation to dosing, drug to drug interactions and potential treatment related outcomes.

Discuss expected therapy goals and desired outcomes from introduction of metformin including monitoring and evaluation of treatment outcomes, make recommendations for continued therapy based on patient factors and disease management.

Discuss patient education in relation to drug adherence.

Discuss risk and benefits of drugs and conditions that may need dose adjustments

Dosing Considerations

In essence, the issue surrounding diabetes has no doubt gain traction in the clinical discourses particularly in the contemporary world. According to researches, the number of individuals diagnosed with diabetes has recently gone up something which medical scientists attribute it to the overall change of lifestyle. Consequently, there are various medications procedures that have been set aside with an aim of treating this illness across the globe. One main medication that has been tipped for this purpose is the metformin. Ideally, metformin is a type of medication that is used to treat patients with type 2 diabetes. The overall function of metformin is to lower the level of blood sugar by improving the manner in which an individual’s body handles insulin (Zaccardi et al., 2016). Notably, this medication is often prescribed particularly for diabetes in case diet as well as exercise has not been sufficient in controlling the level of blood in a patient’s blood. This paper proposes to discuss in detail a pharmacotherapy plan supporting the choice and need to prescribe a metformin and discuss the pharmacotherapeutic considerations in relation to dosing, drug to drug interactions and potential treatment-related outcomes, discuss expected therapy goals and desired outcomes from introduction of metformin including monitoring and evaluation of treatment outcomes, make recommendations for continued therapy based on patient factors and disease management (Sonesson, Johansson, Johnsson, & Gause-Nilsson, 2016). Discuss patient education in relation to drug adherence. Discuss the risk and benefits of drugs and conditions that may need a dose adjustment. The paper will do this in reference to 45 years patient in respite care.

In essence, metformin often comes along with a rather information of patients inserted in a plan. In case of this 45 years old patient who is in respite care, he is required to read the overall information in a careful manner and ensure that he or she understands it before taking the required metformin. At this point, patients are supposed to ask any question to their doctors if they have any.

Primarily, the 45 year old person is then supposed to follow the meal plan as provided by their doctors. Notably, this is considered a crucial step especially for controlling a person’s condition and is essential if the medicine is intended to work (Tahrani, Barnett, & Bailey, 2016). Additionally, there is a need for a directed exercise in a regular manner while testing for sugar in a patient’s blood or rather their urine.

Drug Interactions

Metformin is supposed to be taken alongside meals with an aim of helping reduce stomach or rather bowel side effects that may happen within the first weeks of treatment. The 45 years old patient should swallow the tablet or instead of the extended-release table, where some part of the tablet may then pass through a person’s stool especially after their bodies have already absorbed the medicine. Notably, this should be a normal occurrence and there should be no need for panic. The tablet should be swallowed by taking a glass full of water while not crushing or even chewing it.

Furthermore, the oral liquid is to be measured by the use of a marked measuring spoon, oral syringe, or even medicine cup. Apparently, this is because the average household teaspoon may sometimes fail to hold the right amount of intended liquid. One thing that a patient has to keep in mind is the fact that they are supposed to use only the metformin that their doctors have prescribed for them. Notably, this is because various brands may not work for the purpose of treating diabetes.

Within approximately one to two weeks, the 45 year old patient may be able to notice some improvement. However, full effect regarding blood glucose regulation takes nearly two to three months (Lu, Min, Chuang, Kokubo, Yoshida, & Cha, B2016). At this point, a patient may feel free to ask his or her doctor any question that one might have regarding the same.

Primarily, there are various reasons why there is a need to prescribe a metformin to a diabetic individual. One clear reason for the medical practitioners to prescribe metformin to a patient is because it is proven to extend the life of an individual in the long run. According to research, metformin has for long been associated with nearly 24 percent lower causes of mortality as compared to patients who chose not to take metformin. Additionally, metformin is tipped to produce a modest weight loss strategy while normalizing hypertension. In this case, it ought to be useful to the patient at hand given that he has some hypertension complication. The use of metformin is as well thought to improve heart failure while preserving the kidney thus regarded as one of the best medication for diabetes type 2. In this light, there is a need for prescribing metformin. Metformin would help the 45 year patient in this case to control diabetes illness and, therefore, helping an individual’s body responds well to insulin a body naturally produces.

Expected Treatment Outcomes

There is a various consideration that medical practitioners set aside before they decide the type of dosing an amount that a particular patient requires a treatment process. In this light, the dosing of metformin is no doubt different for different type of patient. One has to follow the orders that are given by the doctors as well as the directions on the label. In case the dose of a particular patient is different, one is not supposed to change anything unless there is a clear direction by the doctor to change on the same. Moreover, the amount of medicine that an individual takes hugely depend on the on the overall strength of that particular medicine. Another factor of consideration in the dosing process is the medical problem that one might be facing in which the medicine is prescribed. Consequently, this defines the number of dosses one take every day, the overall time allowed between each dose, as well as the number of doses one take each day that an individual takes.

Despite the fact that it is not advisable to use certain drugs together, there are some cases where two or more medicines are used together even though an interaction may occur. In such cases, doctors can sometimes change the overall doses that are prescribed to a patient or even use other precautions that may be relevant. In case one is taking metformin it is important if an individual’s health care professional understand if one is taking any other medicine. There are some medicines that are not advisable to be taken alongside metformin. Some of these medicines include Iopanoic Acid, Diatrizoate, Iobenzamic Acid, Iopromide, and Iodipamide. Nonetheless, there are those medicine that although they are not often recommended to be taken with metformin, it can be can be used at some stages. Some of these medicines include Aspirin, Norfloxacin, Balofloxacin, and Bupropion. The reason why it may not be advisable to sometime take these medicines alongside metformin is simply that they can result in a rather increased risk of various side effects.

Primarily, amlodipine besylate is active alone as a rather add-on therapy diverse classes of agents. In this light, Amlodipine in most cases improves the endothelial function as well as inflammation. Notably, the use of this medication can be helpful in improving cardiovascular outcomes.

In essence, metformin is regarded as an antihyperglycemic agent that is tasked with improving the overall glucose tolerance in the 45 years old with type 2diabtes. In this light, the point of action of metformin is lowering not only the basal but as well the postprandial plasma glucose. Primarily, this is considered as a pharmacological tool of action is quite different from other common antihyperglycemic agents. Consequently, metformin is tasked at decreasing hepatic glucose production, reduces the overall absorption of glucose by the intestine, while improving the sensitivity of insulin through increased peripheral uptake and utilization of glucose. Different from sulfonylureas, metformin does not tend to produce hypoglycemia in type 2 diabetes patient or on a person in a normal state.

Patient Education

Goals

Ideally, every medication strategy is guided by some specific goals to achieve a particular intended outcome. In this light, there are various general goals for a therapy in treating diabetes when using metformin. Consequently, the general goal of this therapy when treating a diabetic patient is to minimize the overall acute decompensation,  maintain a good quality of life, and prevent or rather delay the appearance of other late illness and complications. In this light, a patient has to meet therapeutic objectives in the treatment of diabetes. Notably, Glycosylated hemoglobin (HbA₁c) is often regarded as the best index of the overall control of diabetes given the fact that it tends to provide information regarding the degree of the glycemic control particularly in the last two or rather three months thus remaining below 7 percent. However, in patients who are older and have low expectancy, it is imperative to get a therapeutic target due to the fact that that it entails a rather higher risk of resulting in severe hypoglycemia. Regarding the target value particularly for the lipid profile as well as the blood pressure of a patient, it is important to keep in mind that some diseases such as the ischemic heart illness are the major cause of death among the diabetic patients. Consequently, the overall cardiovascular for the diabetic patients is often the same to the patients who are free from diabetes and have already ischemic heart illness. Therefore, the overall targeted values that are required for the diabetic populace has to be strict as well as similar to those need in patients that have established coronary illness.

Desired Outcomes

By using metformin, there is no doubt various outcome that is expected in the 45 years old patient suffering from diabetes type 2. It is clear that heart failure has become very common in patients suffering from diabetes. In this light, one expected outcome of using this therapy is to lower the risk of a patient developing heart failure (Hadjadj, Rosenstock, Meinicke, Woerle, & Broedl, 2016). Another endpoint of conducting metformin therapy is the aspect surrounds the quality of life of a particular patient. In this light, the medication is aimed at lowering other risks that a diabetes patient may be exposed to such as heart failure. Life expectancy is another outcome that is of high concern particularly for patients who are considered as old adult. In this case, the current therapy is tipped to increase the overall life expectancy of a patient. Moreover, metformin therapy intends to reduce cognitive impairment or rather the overall cognitive status of a patient in the long run.

Monitoring a patient’s progress especially within the first few weeks that a patient takes metformin is important for a full recovery stage. In this light, various blood samples, as well as urine tests, are essential in checking the unwanted effects during medication.

In some cases, metformin may tend to interact with the dye that is often used for the X-ray or rather the CT scan. Consequently, doctors are supposed to advise a patient to stop taking the medicine before having any particular medical examination or rather diagnosis test that may tend to cause less output of urine. For a good monitoring, one may be advised to begin taking metformin in close to 48 hours after an examination in case the kidney functioning of that particular patient is tested and thereafter found to be normal.

Furthermore, it is important to make sure that any particular doctor or even dentist that is under the care of a diabetes patient understands that the patient is using metformin. It is as well advisable if on stops using a metformin some days before undergoing a surgery or rather a medical test (Chrvala, Sherr, & Lipman, 2016). In some cases, taking too much metformin can result in a lactic acidosis in a patient body. In this case, monitoring a patient is important and therefore making he or she take medical assistance before it such situation worsens.

For the purpose of evaluation, it is clear that the use of metformin goes a long way in controlling and treating patients with type-2-diabetes (Shanbhogue, Mitchell, Rosen, & Bouxsein, 2016). However, there is a need for a close monitoring of patients under medication to achieve the desired outcome in the long run (Bilezikian et al., 2016). For this to happen doctor have to be aware at every point if a patient is under the metformin therapy. This is the only way that a close and successful monitoring process can be done.

It is true that one of the foundation treatments of diabetes type two especially for older adult is adherence to lifestyle change particularly focusing on diet, increasing overall physical activities as well as exercise, and the reduction of weight that is often reinforced by various consultations with a registered body of dietitians and through self-management of diabetes (Shyangdan, Uthman, & Waugh, 2016).

After undergoing a rather successful response of metformin therapy, most patients often fail to keep up the targeted levels of glycated hemoglobin (A₁C) particularly during consecutive three to five years of medication. For most patients, it is recommended that they undergo a second medication especially when the individualized glycemic treatment objectives or rather goals have not been achieved after metformin as well as lifestyle intervention (Dujic et al., 2016). In essence, this decision is often grounded on the A1C examined outcomes that are usually undertaken after every three to about six months after the first therapy.

In case there are patients who fail to achieve their objective on the first therapy, there are various recommended classes of medications that are often tipped to be used alongside metformin. Notably, these options include insulin, glucagon-like peptide-1 (GLP-1) agonists, repaglinide, and insulin (Kohler et al., 2016). However, patients should take note that all the recommended medications have their advantages and disadvantages especially on their overall effect to a particular patient.

Primarily, for those patients that record A1Cgreater than 8.5 percent on the overall metformin, or even having obstinate symptoms of hyperglycemia, it is recommended that they add insulin or rather the GLP-1 receptor agonist (American Diabetes Association, 2016). Despite the fact that basal insulin has for a long time been preferred medicine to be added during a metformin therapy especially when A1C is elevated, GLP-1 receptor agonist is considered as a practical option. Moreover, there are those patients who are thought to have established a cardiovascular illness or even heart failure (Storgaard, Bagger, Knop, Vilsbøll, & Rungby, 2016). In this light, the use of a specific GLP-1 receptor agonist which has initially showcased cardiovascular advantages can be used while assuming that they acquired the targeted outcome in the long run.

For those patients with a recorded A1C which is less than or equal to 8, it is recommended that the choice of the second metformin is individualized grounded on the efficacy, the overall patient’s comorbid condition, impact on the weight, and of hypoglycemia (Steven et al., 2016). In case there are patients who have inadequate glycemic control particularly on a double therapy, the selection criteria have to be individualized which are similar to those that are performed for patients with mono-therapy failure and grounded on the overall efficacy.

It is recommended that those patients that fail to achieve targeted A1C with the first dual therapy then they ought to start on insulin or rather the GLP-1 receptor agonist (Lipska, Krumholz, Soones, & Lee, 2016). Additionally, for all patients that are on sulfonylureas as well as metformin who are in their early stage of using insulin, are often required to be tapered while discontinued. In this case, the metformin is as well continued.  Furthermore, there are those patients who have a history of myocardial infections or even the stroke, thus they are recommended to take two oral agents as well as a GLP-1 agonist. Another recommendation for patients who are close to goals regarding glycemic is the use of three goals.

Medication adherence is regarded to the whether a particular patient is taking this or her medications as recommended by the doctors as well as whether they stick to the prescribed medication in the long run (Sastre, Vernooij, Harmand, & Martínez, 2017). The overall non-adherence of medication is no doubt topic that has gained traction in recent times particularly to the pharmacists (Rosenstock et al., 2016). It is even worsening that there is a limited measurement that is associated with the patient’s adherence to medication in most clinical practice in contemporary society. Consequently, designing a reliable patient educations strategy for drug adherence is important. While there are various cases of non-adherence to drugs as prescribed by doctors, not all prescription misuse is always intentional (Søfteland et al., 2016). In most cases, unintentional non-adherence happens in case a patient desire to follow their treatment plans but they are faced with various challenges that they cannot control.

One clear educational activity that nurses can use to minimize instances of drug non-adherences is through engaging patients in issuing a prescription. In this light, nurses are can include patients in the overall decision-making process particularly when issuing prescriptions (Goldstein & Müller-Wieland, 2016).  Essentially, a more collaborative approach, in this case, is likely to increase the patient’s cooperation. Through engaging the patient in the decision making, medical practitioners allow the patients to have a sense of ownership; something that makes them to feel that there is more invested in them in terms of their own recovery (Ahrén et al., 2017). Moreover, car providers can as well boost the aspect of prescription compliance through coming up with a rather simple drug regime.

Through communication, care providers are in a position to explain the important detail in a prescription that a patient ought to follow and it is supposed to be followed in the right way (Tseng, 2016). At this time, medical practitioners are able to educate the patients regarding the type of medication they are prescribed too and the way they are supposed to follow them. Additionally, it is as well important to educate the patients concerning the side effects that might come along with a particular prescription (Nauck et al., 2016). Metformin therapy is very delicate and thus requires patients to have adequate information on how they can follow the designed prescription.

One of the most common factors that lead to non-adherence is the aspect of being forgetful. At some point, nearly half of patients prescribed to take medication to forget to take them (Qaseem, Barry, Humphrey, & Forciea, 2017). In this case, nurses tend to apply a common tool with an aim of helping patients remember to follow their treatment regime, including postal mails, email, voice messages as well as text messages (Chapman, Darling, & Brown, 2016). Through education, nurses are in a position to remind their patients to regularly check their emails and thus following their prescription to the end of the therapy. Additionally, nurses are can help their patients interpret the details of their prescribed medication to avoid instances where one cannot understand medication details presented. This can be helpful especially for patients who have a complicated prescription regime that is spread throughout their daily routines.

In essence, there is no effective medicine that lacks risks thus every medicine has its own side effects which can sometimes occur in some patients (Gæde et al., 2016). Notably, this is one of the main reasons why the benefit of a particular medicine should always outweigh the risk of the same. There are various benefits of metformin which makes it a good medication for diabetes type 2. Ideally, metformin promotes good gut bacteria growth (Chatterjee, Khunti, & Davies, 2017). According to recent research, metformin has been tipped to change gut microbiota in a rather favorite direction. Essentially, this is made possible by enabling the development of mucin-degrading.

Furthermore, metformin is used in preventing the pre-diabetes from developing type—diabetes (Tian et al., 2016). While the change in lifestyle behavior often assists in preventing those that are considered to have pre-diabetes particularly from developing type 2 diabetes, thus helping type 2diabtes prevention or even delay. Another benefit of metformin is that it helps a patient to be protected glaucoma.

Despite metformin having various benefits that have led to the adaptation in the medical discourses especially for diabetes, it has some level of risks. Some of the risk that a diabetic patient may encounter after using, metformin include Gastrointestinal adverse effects, diarrhea something that only occurs in less than 20 percent of patients that use metformin (Wu et al., 2016). Nonetheless, the life-threatening risks that are connected to metformin are very rare in society and therefore be avoided by adhering strictly to the prescribed guidelines by the doctors.

Conclusion

It is evident that diabetes has become rampant in contemporary society something that has hugely been attributed towards lifestyle. Notably, lack of physical activities as well as diet has to some extent contributed to overweight in people leading to obesity and thus diabetes. Essentially, diabetes has mostly affected older people, in this case the 45 year old with cellulitis in her left, thus subjecting people to risks such as heart failure, stroke, and hypertension. For this reason, setting up measures to improve the quality of life of patients with diabetes is important. One measure that has for a long time been used for the purpose of controlling diabetes is the use of metformin therapy. Despite the fact that this medication has some risk, their benefits outweigh the risk thus making it effective for treating diabetes.

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