A 38-year-old man with type 2 diabetes who gained weight on glyburide and had improved HbA1c on metformin; after discontinuing glyburide, which medication would be most beneficial to add?

A 38-year-old man with type 2 diabetes who gained weight on glyburide and had improved HbA1c on metformin; after discontinuing glyburide, which medication would be most beneficial to add?

• A. Liraglutide
• B. Insulin
• C. Pioglitazone
• D. Phentermine

Answer: (A)

When a patient with type 2 diabetes has gained weight on a sulfonylurea, the best next therapy is one that improves blood sugar control without adding more weight—and ideally promotes weight loss. Liraglutide, a GLP-1 receptor agonist, fits this goal. It lowers HbA1c and typically leads to meaningful weight loss by slowing gastric emptying and increasing satiety, which helps counteract the weight gain aspect seen with sulfonylureas like glyburide. It can be used in combination with metformin and often provides cardiovascular benefits as well. In contrast, insulin and pioglitazone tend to cause weight gain and can complicate weight management, while phentermine is a weight-loss agent that does not address glycemic control in diabetes. Thus, liraglutide offers dual benefits for someone needing ongoing diabetes management with a focus on reducing weight.

When a patient with type 2 diabetes has gained weight on a sulfonylurea, the best next therapy is one that improves blood sugar control without adding more weight—and ideally promotes weight loss. Liraglutide, a GLP-1 receptor agonist, fits this goal. It lowers HbA1c and typically leads to meaningful weight loss by slowing gastric emptying and increasing satiety, which helps counteract the weight gain aspect seen with sulfonylureas like glyburide. It can be used in combination with metformin and often provides cardiovascular benefits as well.

In contrast, insulin and pioglitazone tend to cause weight gain and can complicate weight management, while phentermine is a weight-loss agent that does not address glycemic control in diabetes. Thus, liraglutide offers dual benefits for someone needing ongoing diabetes management with a focus on reducing weight.