Diabetes medication question

[Phloston]

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I have annotated in my FA from Kaplan QBank that sulfonylureas are the first-line Tx in DM-II. I even specifically recall having selected metformin as the answer to one of their quesions for 1st-line Tx in DM-II, but sulfonylureas was the correct answer. They specifically said sulfonylureas are first-line Tx over metformin based on the higher risk of side-effects with the latter.

Anyway, p. 333 of FA says for biguanides: "first-line therapy in type 2 DM."

Does anyone have any thoughts on this?

 

[ijn]

Metformin is first line unless they have some contraindication like impaired renal function, in which case you can go to 2nd generation sulfonylureas as first line. But typically a sulfonylurea is an add-on drug when metformin and lifestyle modification aren't sufficient to control the person's diabetes.

 

[MrBigglesworth]

First line: diet and exercise 😀

 

[ijn]

First line: diet and exercise 😀

They are actually now recommending lifestyle modifications + metformin as the initial treatment at diagnosis rather than waiting for lifestyle modifications alone to fail. It's such a benign drug in terms of side effects, delays the progression of DM, and decreases mortality so there's no real reason to wait.

 

[Phloston]

Thanks for the input.

Btw, now that I'm going back through my annotated FA, most of what I have written in orange (Kaplan) seems to stand as a joke more than anything else.

 

[thegreatergood]

Thanks for the input.

Btw, now that I'm going back through my annotated FA, most of what I have written in orange (Kaplan) seems to stand as a joke more than anything else.

What do you mean by that? Is Kaplan's stuff not accurate or is it just low-yield details? I'm doing the Kaplan Qbank now and am kind of debating how much to add to First Aid.

 

[Phloston]

What do you mean by that? Is Kaplan's stuff not accurate or is it just low-yield details? I'm doing the Kaplan Qbank now and am kind of debating how much to add to First Aid.

Let me make a point clear. I learned a a lot from doing the QBank, and I do recommend annotating most of what you find important. However, some of their answers notably contradict other resources I've used, particularly in the behavioral science department.

I have my FA annotated in green for UWorld, orange for Kaplan, and blue/black for USMLE Rx and other resources. Now that I'm practically a month-out and am doing my final serious pass of FA, I just happen to notice that the stuff written in orange, compared to most everything else, is mostly obscure details which I now realize would never in a million years show up on the USMLE. I'm only aware of this now that I've done five NBME exams, which have given me a little flavor of the stuff the USMLE actually focuses on, whereas before, I was OCD about learning every detail. The long story short is that I'd like to memorize everything in my annotated FA, but as humans we only have so much capacity; whenever I encounter Kaplan details, I just laugh at how ******edly low-yield so many of them are. I'm just annoyed that Kaplan is off the mark with pretty much all of their resources. They don't teach concise USMLE prep. They just teach a broader, relatively unguided medicine course.