AADE STUDY

A 38-year-old man with type 2 diabetes and an A1C of 8.7% stopped taking metformin 500mg twice daily due to persistent diarrhea. Which of the following is most likely to achieve his A1C goal of less than 7%? Liraglutide Canagliflozin Saxagliptin Glimepiride - Correct Answer- D - Glimepiride is correct. Biguanides and sulfonylureas lower A1C up to 2%, while other agents only lower A1C by 0.5% to 1%, including: GLP-1 receptor agonists like liraglutide (Answer A); SGLT2 inhibitors like canagliflozin (Answer B); DPP-4 inhibitors like saxagliptin (Answer C). A 36-year-old pregnant woman with gestational diabetes inadequately controlled with diet and exercise presents for follow-up. She and her husband have tried to become pregnant several times without success, and they are very concerned about the effects of drugs on the fetus. Which of the following would be the most appropriate addition to her regimen? Glyburide Metformin Liraglutide NPH insulin - Correct Answer- D - NPH insulin is correct. Recombinant human NPH insulin is preferred during pregnancy due to its amino acid structure and long history. Several meta-analyses suggest that glyburide (Answer A) is inferior to metformin and insulin due to increased risk of neonatal hypoglycemia and macrosomia. About 50% of the metformin dose crosses the placenta but is not associated with adverse effects on the fetus; however, metformin may slightly increase the risk of prematurity (Answer B). The GLP-1 receptor agonists (liraglutide, Answer D) are all FDA Pregnancy Category C