Dr. Dhruvi Hasnani: Management of PCOD and hyperglycemia
CASE OVERVIEW
Type 2 diabetes (T2D) has long been identified as an incurable chronic disease based on traditional means of treatment. The best outcome that has been expected is amelioration of diabetes symptoms or slowing its inevitable progression. A 32-year-old female patient reported to the Dr Dhruvi Hasnani clinic after a reference from gynaecologist for her PCOD condition. The patient reports a family history of Type 2 diabetes from her grandparents. Her primary complain was an irregular menses for which she consulted a gynaecologist who diagnosed her with polycystic ovarian disease and hyperandrogenism. She was 98.5 kg with160cm of height accounting for 38 kg/m2 of BMI.The patient also showed signs of Acanthosis nigricans and central obesity which is typical for type 2 diabetes patients with PCOD.
DIAGNOSIS
She has RBS: 198mg/dl, BP: 150/100 mmHG, Pulse: 96/min, S testosterone: 226.81 ng/dL, FSH: 7.39 mIU/ml, LH: 2.38mIU/ ml. Her laboratory analysis for metabolic syndrome revealed HbA1c: 8.8%, Triglycerides: 397 mg/dl, LDL: 116 mg/dL, HDL:42 mg/dL, S Creatinine: 0.9 mg/dL, TSH: 4.58 micro u/ml. She was diagnosed with PCOD and hyperglycemia.
RESULTS
At the end of 3 months the reports revealed FBS: 97mg/dl, PPBS: 144mg/dl, HBA1c: 6.7%, BMI: 35.2 (8 kgs weight loss). Recent follow up concludes that her menses has been regularised. Her HbA1c persistently has been observed to be below 6%. Her BMI currently is 29 kg/m2 with weight fluctuations between 76 to 79 kgs. Her metabolic profile stays within normal limits and she is more confident in her body now.
TREATMENT
She was initiated on combination therapy of metformin, SGLT2i and DPP4i which were gradually up titrated to a full dose for resolving of her signs and symptoms of PCOD and management of hyperglycaemia. Individualised medical nutrition therapy and consultation from a physiotherapist to help her adhere to lifestyle modification were incorporated.
Tele consultation during pandemics intended to motivate her for moderate physical activity at home along with adherence to the nutrition. Glucagon-like peptide-1 (GLP-1) receptor agonists was included after withdrawal of DPP4I for the treatment of diabetes, with benefits extending outside glucose control, including positive effects on weight, blood pressure, cholesterol levels, and beta-cell function. She was advised to maintain a strict SMBG diary for monitoring purposes along with her abdominal girth medium thickness and mid-thigh thickness.
