What would be your treatment step to get patient at goal?
56-year old female with type 2 diabetes, BMI of 30 kg/m2 and no major comorbidities, has been on metformin and a sulfonylurea at their highest tolerated doses. Four months ago, her previous physician added a high dose of a DPP-IV inhibitor to help get her to goal of 7%. The treatment regimen brought the A1C to 7.6%. The patient is seeking a second opinion.
Would you consider switching any medications or adding on? Please list what would be your preferred options.