CT was diagnosed with type 2 diabetes three years ago. The current medication regimen includes 1000 mg of metformin twice daily and 70 units of glargine at night. CT wears an intermittent sensor, and you look at the glucose trends together on CT’s phone app. You both agree that there are consistent postmeal spikes up to 250 almost every day after lunch and dinner. The lowest blood sugar readings are in the 100s. BMI is 33.8 and CT says, “I never feel full”. The most recent A1C is 8.2%, urinary albumin creatinine ratio less than 30.
Based on this information, what intervention would be most likely help CT get to recommended ADA targets?
- Add on low-dose sulfonylurea to prevent hypoglycemia.
- Suggest adding a GLP-1 Receptor Agonist.
- Hold metformin, and switch to basal-bolus therapy.
- Encourage CT to get more active, especially after meals.
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