PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization

PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization

PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization. Current medications include dicyclomine 10 mg po QID prn abdominal pain, pantoprazole 40 mg po daily 30 minutes before breakfast, losartan 50 mg po daily, and probiotics daily. His lab work today includes: BG 196 mg/dL, A1C 8.6%, K+ 4.2, Cr 1.8, eGRF 27, BP 127/74. What treatment plan would you implement

for PL (include complete medication order)? What is the classification and MOA of the drug you selected; why is it the best treatment option for PL? What education would you provide and how would you monitor the effectiveness of the treatment plan? What is his goal A1C?

PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization

Scenario 4: PL – Poorly Controlled Type 2 Diabetes

PL is a 63-year-old male with poorly controlled type 2 diabetes (A1C 8.6%) and stage 4 chronic kidney disease (eGFR 27). His current regimen does not include glucose-lowering therapy, and metformin and SGLT2 inhibitors are contraindicated due to renal impairment. An agent effective for glycemic control, cardiovascular protection, and renal safety is needed.

Drug Therapy Plan

Semaglutide (Ozempic) 0.25 mg SC once weekly × 4 weeks, then increase to 0.5 mg SC once weekly as tolerated, #1 pen, 1 refill

Class: GLP-1 receptor agonist.

MOA: Mimics glucagon-like peptide-1 to enhance glucose-dependent insulin secretion, suppress glucagon release, slow gastric emptying, and promote satiety, thereby lowering blood glucose and A1C (Kommu & Whitfield, 2024).

Rationale

Semaglutide is safe in renal impairment, reduces cardiovascular risk, aids weight loss, and is highly effective for lowering A1C (MacIsaac, 2025).

Avoid metformin (contraindicated with eGFR <30) and SGLT2 inhibitors (ineffective at low GFR) (Yau et al., 2022). Monitoring Recheck A1C every 3 months to assess response (goal <7.0%, individualized). Monitor renal function (Cr, eGFR). Watch for GI side effects (nausea, vomiting, diarrhea). Educate the patient to report symptoms of pancreatitis or severe abdominal pain. BUY A HUMAN-WRITTEN PAPER HERE Patient Education Demonstrate proper injection technique. Stress consistent weekly dosing schedule. Discuss lifestyle: diet (carb moderation, portion control), physical activity, and weight management. Reinforce the importance of BP and glucose self-monitoring. Goal A1C 8.0-8.5% because the patient has significant comorbid conditions, and the aim is to avoid the risks of hypoglycemia from more aggressive blood sugar lowering (American Diabetes Association, 2018). PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization References Al-Hashimi, N., & Abraham, S. (2024, January 10). Cholecalciferol . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549768/ American Diabetes Association. (2018). Glycemic targets: Standards of medical care in diabetes—2019. Diabetes Care , 42 (Supplement 1), S61–S70. https://doi.org/10.2337/dc19-s006 Betchel, N., & Saadabadi, A. (2023). Lamotrigine . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470442/ Delgado, B. J., & Bajaj, T. (2022, February 15). Tiotropium . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK541127/ Dighriri, I. M., Nazel, S., Alharthi, A. M., Altowairqi, N. A., Albariqi, A. M., Tohari, M. A., Alameer, A. A., Alsaran, A. K., ALshammari, F. R., AlMutairi, N. F., Alsubaie, F. M., & Alharbi, T. A. (2023). A comprehensive review of the mechanism, efficacy, safety, and tolerability of Ubrogepant in the treatment of migraine. Curēus . https://doi.org/10.7759/cureus.48160 Hsu, E., & Bajaj, T. (2023, June 20). Beta 2 agonists . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542249/ Irelli, E. C., Cocchi, E., Morano, A., Gesche, J., Caraballo, R., Lattanzi, S., Strigaro, G., Catania, C., Ferlazzo, E., Pascarella, A., Casciato, S., Quarato, P. P., Pizzanelli, C., Pulitano, P., Giuliano, L., Viola, V., Mostacci, B., Fortunato, F., Marini, C., & Gennaro, G. D. (2023). Levetiracetam vs lamotrigine as first-line antiseizure medication in female patients with idiopathic generalized epilepsy. JAMA Neurology . https://doi.org/10.1001/jamaneurol.2023.3400 Johnson, D. B., & Bounds, C. G. (2024, January 10). Albuterol . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482272/ Kalola, U. K., & Ambati, S. (2023, August 28). Budesonide . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563201/ Kommu, S., & Whitfield, P. (2024, February 11). Semaglutide . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK603723/ Kumar, A., Sharma, S., & Gupta, V. (2023). Donepezil . National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513257/ MacIsaac, R. J. (2025). Semaglutide: A key medication for managing cardiovascular-kidney-metabolic syndrome. Future Cardiology , 1–21. https://doi.org/10.1080/14796678.2025.2511412 Pellesi, L., Garcia-Azorin, D., Rubio-Beltrán, E., Ha, W.-S., Messina, R., Ornello, R., Petrusic, I., Raffaelli, B., Labastida-Ramirez, A., Ruscheweyh, R., Tana, C., Vuralli, D., Waliszewska-Prosół, M., Wang, W., & Wells-Gatnik, W. (2024). Combining treatments for migraine prophylaxis: The state-of-the-art. The Journal of Headache and Pain , 25 (1). https://doi.org/10.1186/s10194-024-01925-w Remien, K., & Bowman, A. (2024). Fluticasone . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK542161/ Shahrokhi, M., & Gupta, V. (2023, May 1). Propranolol . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557801/ Wang, G., Estrella, A., Hakim, O., Milazzo, P., Patel, S., Pintagro, C., Li, D., Zhao, R., Vance, D. E., & Li, W. (2022). Mini-mental state examination and Montreal cognitive assessment as tools for following cognitive changes in Alzheimer’s disease neuroimaging initiative participants. Journal of Alzheimer’s Disease , 90 (1), 263–270. https://doi.org/10.3233/jad-220397 Yau, K., Dharia, A., Alrowiyti, I., & Cherney, D. Z. I. (2022). Prescribing SGLT2 inhibitors in patients with CKD: Expanding indications and practical considerations. Kidney International Reports , 0 (0). https://doi.org/10.1016/j.ekir.2022.04.094 PL is a 63-year-old male with poorly controlled type 2 diabetes presenting for follow-up and treatment optimization