Often  we see a great deal of misinformation in the care of patients with  diabetes, and often this misinformation is centered around the role and  choice of medications.  Many patients, especially newly diagnosed  patients, are prescribed medications that do not fit into the scheme of  the ADA / AACE guidelines / best evidence based practices – for  instance, starting on Januvia (sitagliptin) or Jardiance (empagliflozin)  or Byetta (exenatide) as initial monotherapy without a compelling  indication or reason.
In this discussion, please talk about  how patients get put on these medications and why/how they should be  transitioned to more evidence based treatments.  

Is it okay to start a patient on a  drug (particularly an oral drug) other than metformin as an initial  drug?  Please cite possible circumstances where this could be  reasonable.
What anti-diabetic medications have  compelling evidence for use in select populations, possibly as initial  therapy, and is this benefit a “class” effect? 

(eg. SGLT2Is – Patients with type 2  diabetes and a high risk of cardiovascular disease had reduced risk of a  cardiovascular death, nonfatal myocardial infarction, or nonfatal  stroke relative to those randomized to receive placebo)

How can patients and practitioners be convinced to change their behavior and opt for more evidence based approach to therapy?

Now lets consider the following case about thyroid disorders. A  69-year-old man goes to his family doctor because he has been feeling  fatigued and lethargic. His doctor does a complete evaluation. This  patient had a myocardial infarction and has a recurrent ventricular  arrhythmia (treated with amiodarone). The patients TSH is elevated and  his T4 is slightly decreased. 

Please provide an evaluation of this patients condition, approach to therapy and factors you have taken into consideration 

Post your initial response by  Wednesday at midnight. Respond to one student by Sunday at midnight.   Both responses should be a minimum of 150 words, scholarly written, APA  formatted, and referenced.  A minimum of 2 references are required  (other than your text). Refer to the Grading Rubric for Online  Discussion in the Course Resource section.