這場研討會在台中李方艾美酒店舉辦，主辦為百靈佳公司，因此案例分享也多為百靈佳公司的藥物，這場學術研討會的講者以及主持人，都是對糖尿病與腎臟病治療有所鑽研的臨床醫師。

瑞東診所杜柏村醫師，在會中分享了5個臨床照護案例，為顧及患者隱私，在此分享一些重要治療轉折及想法，提供大家做參考。

The patient is a 70-year-old male, who has been living with diabetes for more than 30 years and has been taken care of by his wife, who is quite helpful for her husband’s condition .

He has the history of esophageal cancer s/p op and radiotherapy years ago.

He also suffered from CAD-II s/p stenting at medical center.

Due to poor-controlled glucose level, and CKD status, he was brought to our clinic for further intervention.

At the first visit, his HbA1c was 10.8%, and eGFR was 33.42 ml/min/1.72m2 which is CKD stage 3b.

As you can see from the graph below, he was initially under basal-bolus insulin injection, with SGLT2 i use at the same time.

After 2 months’ of follow-up, Jardiance was shifted to Glyxambi, which is the combination of SGLT2 i and DPP4 i.

According to close monitor of SMBG, not much improved glucose level was obtained, therefore, GLP1 RA was initiated, with glyxambi shifted to Jardiance concurrently, together with the use of insulin. Subsequent improvement of HbA1c was noted after medicine adjustment mentioned above, with careful titration of insulin dosage.

Improvement of urine ACR was noted during the course of treatment, which could be attributed to improvement of glucose control and renal protective agent usage, including SGLT2 i and GLP-1 RA.

SGLT2 i is the first-line treatment for diabetic patient with high risk for CKD to prevent the progression of CKD, and also the first-line treatment for CKD, which could delay the timing of entering end stage renal disease.

There is also evidence for GLP-1 RA to lower proteinuria level for diabetic patients.

Improvement of GFR level was also noted as you could see from the graph below.