Initiating Metformin in a Newly Diagnosed T2DM Patient
Patient Name: Mr. Ramesh Kumar
Age/Sex: 52 years / Male
Occupation: Shopkeeper
BMI: 29.5 kg/m² (Overweight)
Chief Complaint: Fatigue, increased urination, and mild weight loss over 3 months.
History & Examination:
Family history: Father had T2DM, diagnosed at age 60.
Personal history: Sedentary lifestyle, non-smoker, non-alcoholic.
Vitals: BP: 134/86 mmHg, HR: 78/min
Physical Exam: No signs of neuropathy, retinopathy or foot ulcers.
Investigations:
Fasting Plasma Glucose (FPG): 146 mg/dL
Postprandial Glucose (PPG): 226 mg/dL
HbA1c: 8.2%
Serum Creatinine: 0.9 mg/dL
eGFR: >90 ml/min/1.73m²
Lipid Profile: Mildly elevated LDL, low HDL
Urine Routine: No albuminuria
Diagnosis:
Newly Diagnosed Type 2 Diabetes Mellitus
Treatment Plan:
1. Lifestyle Modification:
Low glycemic index diet, reduced carbohydrates
Daily 30-minute brisk walk
Weight loss goal: 5-10% of current weight
2. Pharmacologic Therapy:
Drug Initiated: Metformin
Dose: 500 mg once daily with evening meal
Plan: Titrate to 500 mg twice daily after 1 week if tolerated
Target Dose: Up to 1000 mg twice daily if needed, based on tolerance and glucose response
3. Education & Counseling:
Explained the nature of diabetes as a chronic condition
Emphasized adherence and regular monitoring
Advised monitoring for GI side effects (nausea, bloating)
Follow-up at 1 Month:
Symptoms: Energy levels improved, less frequent urination
Side Effects: Mild nausea in first week, resolved on taking tablet with food
Adherence: Good
FPG: 122 mg/dL
PPG: 180 mg/dL
Action: Dose increased to 500 mg twice daily.
3-Month Follow-up:
HbA1c: 6.9%
Weight: Down by 3 kg
BP and Renal Function: Stable
Outcome: Patient continues Metformin 1000 mg/day, good glycemic control, continues lifestyle modification.
Key Learning Points:
Metformin is the first-line agent for most newly diagnosed T2DM patients.
It improves insulin sensitivity and helps in weight control.
Gradual titration reduces GI side effects.
Always monitor renal function before and during therapy.
Lifestyle changes must accompany pharmacotherapy for optimal results.