Interactive case study: GLP-1 and GIP/GLP-1 receptor agonists in type 2 diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.

These three scenarios illustrate the practicalities of prescribing incretin-based therapies for the management of type 2 diabetes, including their indications, contraindications and side-effects.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.

Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.

Susan is a 46-year-old nurse diagnosed with type 2 diabetes three years ago, with an HbA_1c of 74 mmol/mol (8.9%). Achieving satisfactory glycaemic control is proving to be challenging despite being on triple oral antidiabetes therapy.

What target HbA_1c would you advise Susan to aim for, and how would you help her to achieve this?

Ravi is a 55-year-old man with type 2 diabetes, hypertension, dyslipidaemia and diabetic kidney disease. In addition to medications for his lipids and hypertension, he is taking metformin, linagliptin and dapagliflozin, yet HbA_1c remains above target.

What would you do next to improve Ravi’s glycaemic control?

Simon is a 67-year-old man with type 2 diabetes and a history of cardiovascular disease. He is offered a GLP-1 receptor agonist but has severe needle phobia.

What options are available for Simon?

By working through this interactive case study, we will review the practicalities of prescribing incretin-based therapies for the management of type 2 diabetes.