Endocrine Abstracts

Initial presentation: A 44 year-old Caucasian patient with severe and complex obesity and type 2 diabetes was referred to hospital diabetes clinic for optimal medication advice. Her BMI on presentation was 49 kg/m², (148 kg) and HbA1c of 7.0%. Her treatment included metfomin, sulphonylurea, rapid acting insulin (total daily doses 30 unit), and long acting insulin (total daily doses 25 unit). She also suffers complications of hypertension, dyslipidaemia, osteoarthritis, and gallstone cholecystitis.

Management journey: Over the next 12 months, sulphonyuria was successfully switched to SGLT2 inhibitor therapy; through a combination of diet, exercise, and gradual withdrawal of fast acting Insulin, 13 kg weight loss was achieved (down to BMI 44 kg/m²). HbA1c remained at 7.3% or below. Patient is not prepared for bariatric surgery consideration. She did not tolerate Orlistat side effects. It was clear that further weight reduction, and possibility of withdrawing long acting Insulin, could be offered by GLP-1 analogue therapy. However our patient fall outside the low dose GLP-1 treatment criteria in HbA1c, and high dose GLP-1 treatment if currently unavailable through NHS funding.

Conclusion: A substantial population of Obesity patient with type 2 Diabetes would potential benefit from GLP-1 analogues in other important facets of their general health currently not covered by the current NICE guideline. This case highlight points of discussion and perhaps review of current guideline.