Case Study: Ty's Diabetes and CKD Management

Ty is a 65-year-old female with poorly controlled type 2 diabetes mellitus (T2DM) and stage 4 chronic kidney disease (CKD). Her current medications include Donepezil 5 mg at bedtime and Losartan 50 mg daily. Key clinical findings reveal a blood glucose of 190 mg/dL, an A1C of 8.5%, serum creatinine of 1.9 mg/dL, and an eGFR of 26 mL/min/1.73m². Her blood pressure is 125/76 mmHg, and potassium is 4.1 mEq/L. A significant challenge in her care is documented medication nonadherence and possible cognitive impairment, as suggested by her donepezil therapy.

Ty's elevated A1C indicates suboptimal glycemic control, and her advanced CKD significantly impacts medication selection and dosing. The combination of adherence difficulties and potential cognitive impairment further complicates treatment planning. To address these issues, the initiation of a GLP-1 receptor agonist, such as Semaglutide, is recommended. This class of medication is supported by guidelines for T2DM patients with CKD requiring improved glycemic control and cardiovascular protection. A once-weekly formulation is preferred to improve adherence, considering her cognitive status.

Semaglutide is chosen for its effectiveness in lowering A1C, promoting weight loss, and providing cardiovascular and renal benefits. GLP-1 receptor agonists work by stimulating insulin secretion, suppressing glucagon, slowing gastric emptying, and increasing satiety, which leads to improved glycemic control with a low risk of hypoglycemia. These mechanisms make it an ideal choice for Ty's complex medical profile, balancing efficacy with considerations for her adherence and renal function.