Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

Which medication is likely prescribed for a patient with Type 2 Diabetes Mellitus (T2DM) who has renal impairment and refuses insulin?

1. Glucophage (Metformin)

2. Actos (Pioglitazone)

3. Lantus

4. Januvia (Sitagliptin)

The correct answer is: Januvia (Sitagliptin)

In cases of Type 2 Diabetes Mellitus (T2DM) with renal impairment, it is essential to choose a medication that is both effective for blood glucose management and safe for the patient's kidney function. Januvia (Sitagliptin) is a DPP-4 inhibitor that is generally well-tolerated and has a favorable renal safety profile, making it a suitable choice for patients with renal issues. Sitagliptin can be used in patients with varying degrees of renal impairment, and its dosing can be adjusted based on the patient's kidney function. Since it does not require insulin and is effective in managing blood glucose levels through mechanisms that enhance insulin secretion and decrease hepatic glucose production, it is particularly adaptable for patients who prefer to avoid insulin therapy. Other medications may not be suitable due to their contraindications or dosing restrictions in patients with renal impairment. For example, Metformin (Glucophage) is typically avoided in those with significant renal issues due to the risk of lactic acidosis. Thiazolidinediones like Pioglitazone (Actos) may also have limited effectiveness and safety considerations, and Lantus, being an insulin product, is directly not an option for a patient refusing insulin. Therefore, Januvia