Mr. H is a 55-year-old patient with type II diabetes

Mr. H is a 55-year-old patient with type II diabetes mellitus. He has been taking medications for this issue since his late 40s, along with statins for his cholesterol issues, lisinopril for his hypertension, and steroid cream for his intermittent eczema on his arms and legs. Though he reports adherence to a “good” diet he has gained 30 pounds in the last 10 years with a body mass index (BMI) of 35. He takes basal insulin and occasional rapid-acting insulin at mealtimes when he remembers to take his premeal blood sugars. He still has normal renal function and has not been hospitalized for any wound or glucose control issues. He is on metformin at the maximum dose but does complain from time to time about some gastrointestinal issues with this medication. His HgA1C readings are always high. His complete metabolic panel, including liver function tests and complete blood count, is normal. He has a plan in his record to start adding additional medications if his previous goals of weight loss and HbA1C control are not met.
1. Which families of antidiabetic medications might be considered for him as adjunctive medications?
2. How does this adjunctive medication work?
3. Mr. H agrees that more medications are required. However, he refuses to take any more medications that require needles and he refuses an increase in frequent glucose checks. He hates needles. Which of the medications noted above are no longer a first choice for him?
4. He has also heard that some of these newer diabetic medications cause cancer. Which group of medications is linked to thyroid medullary cancer incidence?
5. Because Mr. H has intermittent GI issues with his metformin, are any of the family groups originally considered of potential concern? Why?

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