Sixty-Five-Year-Old Male Needs a Fresh Look at His Diabetes Medication Management
A 65-year-old male presents to you after a referral from the emergency department of a local hospital saw him recently. He has hyperglycemia -- both after fasting (288 mg/dL) and postprandial (180 mg/dL) -- in spite of increasing the dose of his oral antihyperglycemic medications. Currently, he has been prescribed 500 mg metformin three times daily, 1 mg gliclazide twice a day and 30 mg pioglitazone in the morning.
In addition to having hyperglycemia, this patient also complains of nocturia. He isn't sure when the condition began but notes that it is disruptive to his quality of life.
What is your first step in assessing his current medication routine? What, if any, changes would you make to it and why?