Paul is a 41-year-old Caucasian who was diagnosed with Type 2 diabetes 4 years ago. He is a high school teacher. His initial treatment began with 500 mg of metformin twice daily. A year later, the dosage was increased to 1000 mg twice daily. The glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide was added about a year ago to gain better control.
The patient’s A1C remained below 7.0% until now. His fasting blood glucose level has increased from around 125 to 160. He eats a high-fiber, low-fat diet, walks 30 minutes about 5 days a week, and gets 7-to-8 hours of sleep nightly. His blood pressure is 130/80 mm Hg with a heart rate of 70. However, his BMI is 31.4.
His medication regimen is:
Metformin, 1000 mg twice daily
Liraglutide, 1.2 mg daily
Lisinopril, 20 mg daily
Atorvastatin, 20 mg daily
His A1C has risen to 7.8%.
What factors should be considered now that Paul’s Type 2 diabetes has become poorly controlled? What would be your treatment plan for this patient?