Your obese type 2 diabetes patient, who is 58 years old, has been on metformin, but recent HbA1C levels are around 8.2%, despite attempts at controlling diet and exercise. The patient realizes something must be done and would very much like to maximize A1C reductions with the next option, hoping to achieve levels closer to a goal of 7.0%, if not below that, to avoid having to add multiple further medications. However, the patient hopes to avoid injectable medications if they are not completely necessary. The patient would also like to lose weight.

What medication would you recommend next?

Would your recommendation differ if the patient had a history of atherosclerotic cardiovascular disease?

How would you help this patient stay compliant with your prescribed treatment regimen?