Question

Javier is a 45 year old surgical technologist who has been referred to the dental hygiene clinic for "deep cleaning" by his general dentist. He has type 2 diabetes mellitus, but due to his poor glycemic control, recently he has had to add insulin to his drug regimen. His medications include neutral protamine Hagedorn insulin, repaglinide (Prandin), colesevelam (WelChol), simvastatin (Zocor), lisinopril (Prinivil), and a baby aspirin. His blood pressure is 150/94, heart rate is 98, and his respirations are 15 breaths per minute. When you ask him how well his diabetes is controlled, he looks embarrasses and mumbles, "Okay, I guess." When you ask about his A1C, he says it was 8 the last time he visited the doctor. You do a finger stick test, and his results are 250. You asked him when his last visit was to the doctor, and he states that he hasn't been in several months due to a heavy work schedule of surgeries. You ask him if he has eaten because it is late in the day, and you know that he just came from the hospital. He says he has eaten and has take his medications. As you examine his oral cavity, you note that his gingiva is fiery red and erythematous, and he has several areas that appear to be periodontal abscesses. His probe readings range from 4-8mm, and there is spontaneous, excessive bleeding upon probing. The lower anterior mandibular teeth have grade 2 mobility.

Which is the major advantage of repaglinide (Prandin) over other oral antihyperglycemic drugs?
A. Does not have to be taken with meals
B. Positive effect on cholesterol levels
C. Effective at lowering postprandial hyperglycemia
D. Increases insulin sensitivity of adipose tissue, skeletal muscle, and liver
E. Effective sulfonylurea alternative in patients with renal impairment or sporadic mealtimes

Answer 1

The major advantage of repaglinide (Prandin) over other oral antihyperglycemic drugs is that it is specifically effective at lowering postprandial hyperglycemia due to its rapid onset and short duration of action.

Step-by-step explanation:

Javier, a 45-year-old surgical technologist with poorly controlled type 2 diabetes mellitus, has added insulin to his drug regimen due to his glycemic control issues. Among his medications is repaglinide (Prandin) which offers a particular benefit over other oral antihyperglycemic drugs.

The major advantage of repaglinide over other oral antihyperglycemic drugs is that it is effective at lowering postprandial hyperglycemia. Unlike sulfonylureas repaglinide has a rapid onset and a short duration of action which allows it to address blood glucose spikes that occur after meals thereby limiting the risk of prolonged hypoglycemia.