Endocrine Abstracts

Introduction: GLP-1 agonists and metformin are widely used antidiabetic drugs with excellent blood glucose-lowering effects, but patients very often develop side effects. The most common side effect of these two groups of drugs is gastrointestinal intolerance in the form of vomiting, diarrhoea, general weakness and dizziness.Case ReportA 58-year-old male patient was hospitalised for the second time in one month due to a recurrence of dizziness, vomiting, ataxia and epileptic seizures. The patient had a history of type 2 diabetes mellitus treated with GLP-1 agonist dulaglutide 1.5 mg once weekly, metformin 2×1000 mg and glimepiride 2 mg. His medical history included arterial hypertension, hyperlipidaemia, coronary artery disease, OSA syndrome and nicotinism. Performed diagnostic procedures ruled out the neuroradiological cause of the problem and a metabolic cause of the problem was suspected. An electrolyte check was performed and severe hypomagnesaemia Mg < 0.25 mmol/l (0.65-1.05 mmol/l) was found, the other electrolytes were normal (K 3.6 mmol/l, Na 143 mmol/l, Cl 95 mmol/l, Ca 2.38 mmol/l). Due to the weight loss, persistent diarrhoea and gastric discomfort, the patient was suspected of malabsorption due to severe hypomagnesaemia, but this was ruled out by comprehensive gastroenterological treatment (gastroscopy, colonoscopy and abdominal ultrasound revealed no cause of malabsorption, PHD result ruled out coeliac disease and anti-tTG test is ongoing). He was treated with parenteral magnesium supplementation, which resulted in clinical recovery and normalisation of blood magnesium levels. A malabsorption syndrome due to GLP-1 agonists and metformin was suspected. These drugs were excluded from therapy and intensified insulin therapy was introduced. At the next follow-up, the patient was subjectively better, taking oral magnesium supplements and insulin therapy was continued with the basal-bolus regimen for diabetes treatment.

Conclusion: GLP-1 agonists and metformin are excellent drugs in the treatment of diabetes, but it is necessary to pay attention to the rare side effects of these two groups of drugs and to change the therapy if severe side effects occur.