Remission in Type 2 DM with Personalized Medical Interventions Including Life Style Modification and Appropriate Pharmacotherapy - A Case Report

Abstract

Introduction: Increase in prevalence of type-2 diabetes in background of increased prevalence of obesity has increased overall health risk and complicates its management. Health benefits of weight loss and strategies for the same have been found to be effective. Caring for people living with diabetes and obesity requires a person-centred approach using the most appropriate evidence based individualized care. This case study discusses diabetes and weight management in a patient with sub-optimally controlled diabetes and a high BMI with potential for reversal of Diabetes. Clinical Problem: Extremely obese (BMI-43.23kg/m2) middle-aged person with hypertension and diabetes as comorbidity with sedentary lifestyle having sub-optimal glycaemic control (HbA1c 11.2%) with fatty liver disease presented for management of his sub-optimal glycaemic control. Management plan and its rationales with outcomes: Proper education about self-management of diabetes and counselling for importance of weight management and its long-term benefits were explained to patient. Low calorie diet with a calorie deficit of 600 calories per day, one-hour moderate intensity exercise day, SGLT-2i (dapagliflozin 10mg daily), Metformin 2000mg daily, GLP1RA (Liraglutide in incremental dose followed by switch over to oral similitude), Saroglitazar (dual PPAR agonist) along with antihypertensive medication and statin was started in this patient.At 4 months of intervention patient has tolerated the treatment very well and lost 26kg of body weight. His glycated HbA1c came down to 4.2% from 11.2%. Reversal of urine albumin to creatinine ratio to normal range was another significant change. Conclusion: Personalized medical interventions including lifestyle changes and appropriate antidiabetic medication was associated with>25% weight loss, which can potentially induce complete remission of type-2 diabetes.