Every director's round is a collision of wisdom and experience. Today, Professor Zhang, the head of the Department of Cardiology, led his elite team into the ward, as usual, ready to conduct an in-depth analysis of a complex case.
The protagonist of the story is 42-year-old Ms. Li, who has not only suffered from type 2 diabetes for many years, but also suffered from infertility problems caused by polycystic ovary syndrome (PCOS). Recently, her condition has worsened, she was diagnosed with prediabetes, and due to severe insulin resistance, blood sugar control during pregnancy was extremely unstable, which made the attending doctor Xiao Liu feel stressed.
"Director Zhang, this is Ms. Li's case." Dr. Xiao Liu handed over the heavy medical record folder, his eyes flashing with anticipation and nervousness, "The patient's condition is complicated, and we have tried a variety of treatment options, but the results are not satisfactory. Especially regarding the use of metformin, we are a little uncertain. ”
Director Zhang took the medical record, frowned slightly, and began to study it carefully. There was silence in the room, except for the sound of paper flipping. Ms. Li sat on the hospital bed, her hands clenched, her eyes full of longing and anxiety about health.
"Ms. Li, don't worry." Director Zhang's gentle voice broke the silence, "We will tailor a treatment plan that is most suitable for you. ”
Ms. Li raised her head, and a glimmer of hope flashed in her eyes: "Director Zhang, can I still be cured of this disease?" I really want to have a baby. ”
Director Zhang smiled slightly and gave her a firm gaze: "The progress of medicine has given us more possibilities. Metformin is not only a hypoglycemic drug, it also plays an important role in the treatment of PCOS and diabetes prevention. However, we need to adjust your medication strategy based on your specific situation. ”
Then, Director Zhang turned his gaze to Dr. Xiao Liu, with a hint of inquiry in his tone: "Xiao Liu, tell me, in the face of Ms. Li's complex condition, how should we flexibly use metformin?" ”
Dr. Liu took a deep breath and began to elaborate on his thoughts: "Director, I have considered reducing the dose of metformin, but I am worried about affecting the hypoglycemic effect; At the same time, I also considered a combination of drugs, but was concerned about drug interactions. In particular, Ms. Li is still pregnant, so she needs to be more cautious with medication. ”
Director Zhang nodded in understanding, but did not immediately give an answer. He turned to Ms. Li and said, "Ms. Li, your condition is indeed complicated, but we are confident that we can find the best solution. Metformin can improve insulin resistance and promote ovulation in the treatment of PCOS; And in terms of diabetes prevention, it is effective in lowering blood sugar levels. The key is to precisely adjust the dosage and timing. ”
In order to formulate a more precise treatment plan, Director Zhang decided to convene an emergency case discussion meeting. He invited experts from the Department of Endocrinology, Obstetrics and Gynecology and Pharmacy to participate in a lively and in-depth discussion on Ms. Li's case.
During the discussion, the experts expressed their opinions and conducted a comprehensive analysis from the pharmacological effects, dosage, and adverse reactions of metformin, to the patient's liver and kidney function, blood sugar level, pregnancy status, and other aspects. In the end, they reached an agreement: for a complex case like Ms. Li's, the principle of individualized treatment should be adopted, and the dose and medication regimen of metformin should be flexibly adjusted.
The specific scheme is as follows: first, the dose of metformin is adjusted to 1500mg per day, taken in three divided doses, in order to take into account the effect of lowering blood sugar and improving PCOS; At the same time, insulin sensitizers are added to enhance the hypoglycemic effect of insulin; In addition, Ms. Li's blood sugar level, liver and kidney function, and fetal development should be closely monitored, and the treatment plan should be adjusted at any time according to the actual situation.
After the plan was determined, Dr. Liu immediately took action, adjusted the medication for Ms. Li, and explained the precautions in detail. In the following days, Ms. Li strictly followed the doctor's instructions and went to the hospital for regular check-ups. Thankfully, her blood sugar levels gradually stabilized, her PCOS symptoms improved, and more importantly, she successfully became pregnant!
The news got everyone excited. Director Zhang specially praised Dr. Liu during his ward rounds: "The successful treatment of Ms. Li's complex case this time is due to the joint efforts of our team and your accurate grasp of the condition. The off-label use of metformin allows us to see more possibilities, but it also reminds us to be more cautious and scientific in using our medications. ”
Dr. Liu was deeply encouraged and said gratefully, "Thank you Director for your guidance and support. This experience taught me the importance of individualized therapy and the power of interdisciplinary collaboration. I will continue to study and practice hard to provide patients with more accurate and effective treatment. ”
Through Director Zhang Wei's ward rounds and case discussions, we not only witnessed the formulation and implementation of a precision treatment plan for a complex case, but also had a deeper understanding of the off-label usage of metformin and its importance in individualized treatment. The following is a summary and refinement of relevant knowledge points:
1. Off-label usage of metformin:
In addition to being used as a conventional treatment for type 2 diabetes mellitus (T2DM), metformin is also recommended for off-label use in polycystic ovary syndrome (PCOS) and diabetes prophylaxis.
In PCOS treatment, metformin can improve insulin resistance, promote ovulation, and increase fertility.
In diabetes prevention, metformin can effectively reduce the risk of T2DM in people with prediabetes.
2. Principles of individualized treatment:
Ms. Li's case demonstrates the importance of individualized treatment in complex case management. According to the specific situation of the patient, including age, gender, severity of the disease, liver and kidney function status, and pregnancy status, a personalized treatment plan is formulated.
When adjusting the dose and regimen of metformin, it is necessary to comprehensively consider factors such as hypoglycemic effect, improvement of PCOS symptoms, and potential adverse reactions.
3. Interdisciplinary Collaboration and Teamwork:
The successful treatment of Ms. Li's complex case was made possible by interdisciplinary collaboration and teamwork. Experts from endocrinology, obstetrics and gynecology, and pharmacy participated in the discussion to comprehensively analyze the condition from multiple perspectives and formulate the best treatment plan.
Teamwork and effective communication are key to ensuring the smooth implementation of treatment plans and patient outcomes.
4. Medication monitoring and adjustment:
Off-label use of metformin requires close monitoring of the patient's blood glucose levels, liver and kidney function, and changes in condition.
According to the monitoring results, adjust the medication regimen in time to ensure the treatment effect and patient safety.
5. Patient education and communication:
Good doctor-patient communication is a prerequisite for the successful implementation of the treatment plan. Doctors need to explain the treatment plan, medication precautions, and possible adverse reactions to the patient in detail, so as to enhance the patient's confidence and compliance with the treatment.
Patient education is also an important part of improving treatment outcomes and patients' quality of life.
Through this case discussion and summary, we not only deepened our understanding of the off-label use of metformin, but also realized the importance of individualized treatment, interdisciplinary collaboration, and patient education and communication in medical practice. In the future, we will continue to uphold these principles to provide patients with better and more efficient medical services.