Potential Adjunctive Medications for Mr. Wilson’s Diabetes:

Considering his HbA1C, weight gain, and limitations, several families of medications could be considered:

1. DPP-4 inhibitors: These medications (e.g., sitagliptin, linagliptin) are oral, well-tolerated, and don’t require needles or frequent glucose checks. They work by increasing incretin hormones, which stimulate insulin release after meals.
2. SGLT2 inhibitors: These medications (e.g., dapagliflozin, empagliflozin) are also oral and don’t require needles or frequent checks. They work by helping the kidneys remove excess glucose through urine. However, they can cause urinary tract infections and are not suitable for everyone.
3. GLP-1 receptor agonists: These medications (e.g., liraglutide, dulaglutide) are injectable but come in once-weekly formulations. They suppress appetite, promote satiety, and stimulate insulin release. While not ideal due to injections, they might be acceptable due to their infrequent dosing.

Medications to Avoid:

• Rapid-acting insulin: While Mr. Wilson already uses some, increasing the frequency goes against his wishes.
• Sulfonylureas: These medications (e.g., glipizide, gliburide) can cause hypoglycemia, which might be a concern given his needle phobia.

Cancer Concerns:

• Thiazolidinediones (TZDs): This family (e.g., pioglitazone) carries a small but increased risk of bladder cancer and is generally not first-line due to other safety concerns.

GI Issues and Metformin:

• Other DPP-4 inhibitors and SGLT2 inhibitors: Some medications in these families can cause GI side effects, but the specific impact varies. A healthcare professional can assess individual risks and benefits.

Additional Notes:

• It’s crucial to remember that this information is for educational purposes only and does not constitute medical advice. Mr. Wilson’s specific treatment plan should be determined by a qualified healthcare professional who can consider his individual medical history, preferences, and risk factors.
• Newer diabetes medications are continuously being developed and evaluated. Staying informed about the latest options can empower patients to participate actively in their treatment decisions.