PRESENTATION

V.T., a 48-year-old, morbidly obese, Caucasian woman who has had type 2 diabetes for 8 years presented to the diabetes clinic on 24 November 2010. During the previous year, her A1C values were 5.6% on 6 November 2009, 6.6% on 27 April 2010, and 5.8% on 28 October 2010. Through word of mouth, she had heard about a new medication, liraglutide, and inquired about its use for her diabetes.

She had tried to lose weight in the past by watching calories but had minimal success. She stated that she has always been overweight and weighed 217 lb when she first presented to our clinic on 4 February 2005. Her weight has been near 250 lb for 2 years. She asked whether she might substitute liraglutide for some of her present diabetes medications and said she wanted to use a medication that would help her lose weight instead of facing the continued weight gain she was experiencing.

She denied any hypoglycemia, polyuria, polydypsia, or polyphagia. Her medical history included morbid obesity, type 2 diabetes of 8 years' duration, gestational diabetes, hypertension, dyslipidemia, migraine headaches, iron deficiency, vitamin B₁₂ deficiency anemia, peptic ulcer disease, and sulfa allergy.

Her medications included:

• Metformin, 1,000 mg twice daily

• Glimepiride, 4 mg in the morning

• Pioglitazone, 45 mg daily

• Simvastatin, 40 mg before bed

• Lisinopril/hydrochlorothiazide, 20/25 mg daily

• Aspirin, 81 mg daily

• Fish oil, 2,000 mg daily

• Ferrous sulfate, 325 mg daily

• Cyanocobalamin IM, 1 mg every 3 months

• Sumatriptan, 50 mg as needed for migraine headache

V.T.'s physical exam was unremarkable. Her weight was 254 lb, height was 64 inches, and BMI was 43 kg/m². Her laboratory test values are shown in Table 1.

QUESTIONS

1. Will initiating liraglutide and stopping pioglitazone and glimepiride allow V.T. to lose weight while controlling her blood …