We are grateful to the Children's ICU, Cardiology, Genetics, and the ECMO team of KK Women's and Children's Hospital, Singapore, for their expertise in managing this case
Hacia un diagnstico diferencial correcto
Patient-specific factors that influence choice include: Concurrent diabetes : Patients with type 2 diabetes may have broader access through NHS prescribing pathways BMI and weight loss goals : Higher BMI patients may benefit from agents with greater weight loss efficacy Tolerability : Previous experience with gastrointestinal side effects may guide selection Injection preference : Some patients strongly prefer weekly over daily injections, or oral over injectable formulations Cardiovascular disease : Certain GLP-1 agonists have proven cardiovascular benefits, which may be relevant for high-risk patients Ultimately, the choice should be individualised through shared decision-making between patient and clinician, considering the available evidence, licensed indications, local prescribing policies, and patient preferences

Food and Drug Administration (2023) Oral semaglutide versus empagliflozin in patients with Type 2 diabetes uncontrolled on metformin: The PIONEER 2 trial, Diabetes Care (2019) Empagliflozin, cardiovascular outcomes, and mortality in Type 2 diabetes, The New England Journal of Medicine (2015) Empagliflozin in heart failure with a preserved ejection fraction, The New England Journal of Medicine e (2021) Empagliflozin in patients with chronic kidney disease, The New England Journal of Medicine (2022) Semaglutide and cardiovascular outcomes in obesity without diabetes, The New England Journal of Medicine (2023) Effects of semaglutide on chronic kidney disease in patients with Type 2 diabetes, The New England Journal of Medicine (2024) Ozempic drug label information, DailyMed (2023) Jardiance drug label information, DailyMed (2023) Effect of semaglutide on the pharmacokinetics of metformin, warfarin, atorvastatin, and digoxin in healthy subjects, Clinical Pharmacokinetics (2017) Semaglutide injection, Medline Plus (2024) Medically accurate: SingleCares Medical Review Board analyzes all of our content to confirm its in line with current medical advice

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