32-Year-Old Female Diagnosed with Type 2 Diabetes
Maria is 32 and was recently diagnosed with Type 2 Diabetes (T2D). Her recent symptoms include frequent urination, thirst, and irritability.
Her family history includes that her father was diagnosed with T2D when he was 56 and was on oral medication for several years before requiring insulin. In the past year, she relates that she has gained weight and experienced several yeast infections. She has a history of gallstones.
Her fasting lab results include:
A1C = 9.4
Glucose = 220
Urine microalbinuria/Cr ratio = 12 mg/g
eGFR = 86 mL/min/ m2
ALT = 59 IU/L
C-peptide = 4.3 ng/mL
Maria begins taking metformin, with the dose titrated to 2,000 mg daily. The fungal infection beneath her breasts is treated, and she is referred to a diabetic educator and sent for a full dilated funduscopic exam.
Maria returns in three months for evaluation. Her A1C has decreased to 7.7, and she has lost almost 10 lbs. Her eye exam is negative for retinopathy.
What second agent would you add to metformin?