Managing HbA1c and CRP in a hypertensive diabetic patient

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Managing HbA1c and CRP in a hypertensive diabetic
patient
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Hypothetical patient

• Type 2 diabetes
• Hypertension
• Hb1Ac 7.7
• Elevated CRP
• Currently on metformin

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• What is the next step for this patient from a
  glycemic point of view?

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Treatment options

• Lifestyle changes
• Combination therapy
• Metformin plus sulfonylurea
• Metformin plus a thiazolidinedione

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Elevated CRP Sulfonylurea or thiazolidinedione

• In patients with elevated CRP, is a
  thiazolidinedione a better choice than
  sulfonylurea as it could lower the CRP while
  achieving the same HbA1c?

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Thiazolidinediones

• Benefits
• Lower CRP
• No hypoglycemia
• Longer durability of effect
• Reduce inflammation
• Drawback
• Weight gain

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Weight and diabetes New therapies

• GLP1 analogs
• Exenitide
• GLP1-degradation blockers
• Dipeptidyl peptidase 4 (DPP4) inhibitors
• Sitagliptin
• Vildagliptin

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Weight and diabetes New therapies (cont.)

• Drugs to induce weight loss
• Zenecal
• Tolerability problems
• Sibutramine
• Tends to raise blood pressure
• Rimonabant
• Endocannabinoid receptor

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Rimonabant

• In RIO-Diabetes
• Induced weight loss
• Induced HbA1c reductions of 0.7
• Induced CRP reductions

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CRP and diabetes

• CRP measurement important in obese patients
  without diabetes
• Could indicate a risk of diabetes and CVD
• Can stratify risk in patients with type 2
  diabetes across the CRP range
• Uncertain if lowering CRP in diabetics yields any
  benefits