Treatment Recommendations

Question 1

For patients with pre-diabetes, what are the non-pharmacological recommendations for prevention/delay of T2DM?

Answer 1

• Intensive diet and physical activity counseling
• Wt loss of 7%
• Moderate-intensity physical activity of 150 min/week (30 minutes on 5 days/week)

Question 2

Metformin may be considered in which non-diabetic patient populations?

Answer 2

• Patients with IFG, IGT, or A1c 5.7-6.4% especially if BMI >35, age less than 60 years, and women with hx GDM

Question 3

What DM medications are approved for use in pregnancy?

Answer 3

Glyburide, metformin, and all insulins except glargine and glulisine

Question 4

What medications are approved for treating HTN in pregnancy?

Answer 4

1. Methyldopa
2. Labetalol
3. Diltiazem
4. Clonidine
5. Prazosin

Question 5

What are some medications that have been studied (but have yet to receive an FDA indication) for the prevention of DM conversion in pre-diabetes?

Answer 5

No antihyperglycemic agent is approved by the FDA solely for the management of prediabetes and/or the prevention of T2DM

• Metformin
• Acarbose (Precose)
• TZDs (unlikely to be used in prevention d/t long-term adverse effects)
• Orlistat (Alli, Xenical)
• Phentermine/topiramate ER (Qsymia)
• Liraglutide (Victoza, Saxenda)

Question 6

For DM patients with BMI > 30, what is the initial recommended target for weight loss?

Answer 6

Target 5 - 10% weight loss. The method of losing weight is less important than the ability to adhere to the diet.