Dr. Sonali Patange: A case of a woman with diabetes, obesity, primary infertility and PCOS

CASE OVERVIEW

PCOS is associated with hyperandrogenism, ovulatory and metabolic dysfunction, obesity and insulin resistance. A case of 33 year old woman with diabetes with a k/c/o PCOS was presented in the OPD of Dr. Sonali Patange. She had a history of long-standing (12 years) diabetes. Her weight was 87.5 Kg with a BMI of 35.94 kg/m2. She had a history of 2 failed intrauterine insemination and 2 failed in vitro fertilization treatments. She was receiving Glimiperide 4mg twice daily, Metformin 1gm twice daily, Sitagliptin 100 mg once daily and Voglibose 0.3 mg thrice a day.

DIAGNOSIS

Her diagnostic reports reveal HbA1c of 10.5% and eGFR of 70ml/min.

TREATMENT

Dulaglutide 1.5 mg once weekly was initiated and Metformin was continued. Glimiperide was reduced to 4 mg and Voglibose was omitted. Later Empagliflozin 25 mg was added after 3 months, Glimiperide was reduced to 1 mg for 5 months, following which both were stopped. She was counselled for healthy lifestyle interventions.

RESULTS

Dulaglutide introduction helped her to conceive spontaneously. This was diagnosed in 2nd trimester after which dulaglutide was omitted immediately. She had twin pregnancy by surrogacy using donor ova 2 months ago. She was managed with Metformin 1 gm and Humalog in pregnancy and delivered a healthy child.