A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:
A. Prefers to take insulin orally.
B. Has type 2 diabetes.
C. Has type 1 diabetes.
D. Is pregnant and has type 2 diabetes.
Correct Answer: B. Has type 2 diabetes.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Antidiabetic drugs (with the exception of insulin are all pharmacological agents that have been approved for hyperglycemic treatment in type 2 diabetes mellitus (DM). If lifestyle modifications (weight loss, dietary modification, and exercise) do not sufficiently reduce A1C levels (target level: ? 7%), pharmacological treatment with antidiabetic drugs should be initiated.
Option A: These drugs may be classified according to their mechanism of action as insulinotropic or non-insulinotropic. They are available as monotherapy or combination therapies, with the latter involving two (or, less commonly, three) antidiabetic drugs and/or insulin. The drug of choice for all type 2 diabetic patients is metformin. This drug has beneficial effects on glucose metabolism and promotes weight loss or at least weight stabilization.
Option C: Oral antidiabetic agents aren’t effective in type 1 diabetes. All patients with T1DM require insulin therapy. Multiple daily insulin injections (MDI) using a basal/bolus insulin regimen or continuous subcutaneous insulin infusion through an insulin pump are the preferred treatment.
Option D: Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain. Most antidiabetic drugs are not recommended or should be used with caution in patients with moderate or severe renal failure or other significant comorbidities. Oral antidiabetic drugs are not recommended during pregnancy or breastfeeding.
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