For an obese diabetic patient with a history of heart failure, which medication should be added without causing weight gain?

Linagliptin is an appropriate choice for an obese diabetic patient with a history of heart failure because it is a DPP-4 inhibitor that typically does not cause weight gain. Instead, many patients taking linagliptin may experience weight neutrality or even modest weight loss. This characteristic is particularly important for patients who are overweight or obese and may have comorbid conditions such as heart failure.

In contrast, glimepiride and pioglitazone are associated with weight gain. Glimepiride, a sulfonylurea, can stimulate insulin secretion, which may contribute to weight gain as it promotes increased insulin levels that facilitate fat storage. Pioglitazone, a thiazolidinedione, is also linked to weight gain due to fluid retention and adipocyte differentiation.

Inhaled insulin, while effective for controlling blood glucose, can also lead to weight gain as it provides exogenous insulin directly. Insulin therapy typically promotes weight gain as it can increase appetite and leads to fat accumulation.

Therefore, linagliptin stands out as the preferred option in this clinical scenario not only for its efficacy in managing blood glucose levels but also for its favorable effect on weight, making it suitable for an obese patient with diabetes and heart