Description
Case 2.
A 45 year old male with type 2 diabetes comes to see his endocrinologist. His Hba1c
had been 6.7 last visit 6 months back. HIs A1c has now has gone up to 8.2 on recent labs.
He is currently on metformin 1000mg bid. The patient had been following carb counting
but has been non-compliant with his diet lately. He reports fasting glucose in 150-230
range most days. He checks before dinner occasionally and reports glucose usually over
200. He denies any hypoglycemia.
The patient has gained 15 lbs. weight in past 6 months and has a BMI of 39. He does not
have any long term CV complications at this time. Family history is remarkable for both
parents with type 2 diabetes and dad with coronary artery disease and unilateral above
knee amputation. The patient is tolerating metformin well. His BP is well controlled on
lisinopril 10mg daily.
In addition to diet modification, which of the following would be the next best
treatment option for optimizing this patient’s diabetes management?
A. Continue metformin, start Januvia 25 mg daily. Monitor glucose twice a day and
have patient follow up in 3 months. Advice patient to monitor glucose before each meal
and send glucose profile back for review and adjustment in medication in 2 weeks.
B. Discontinue metformin and start patient on basal bolus regime with Lantus and
Humalog. Advice patient to monitor glucose before each meal and send glucose profile
back for review and adjustment in medication in 2 weeks.
C. Continue metformin, start Trulicity 0.75mg once a week. Advice patient to monitor
glucose before each meal and send glucose profile back for review and adjustment in
medication in 2 weeks.
D. Continue metformin, start Jardiance 10mg daily. with plan to add Dpp-4 inhibitor
next visit. Advice patient to monitor glucose before each meal and send glucose profile
back for review and adjustment in medication in 2 weeks.
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