A 48-year-old man with an 8-year history of type 2 diabetes mellitus was referred because of poor glycaemic control. He had a history of myocardial infarction complicated by previous congestive cardiac failure. His current medication comprised metformin 850 mg three times daily and gliclazide 80 mg once daily. He had gained weight and his body mass index was 31 kg/m2 (18C25).
Investigations:
serum sodium143 mmol/L (137C144)
serum potassium4.4 mmol/L (3.5C4.9)
serum creatinine136 µmol/L (60C110)
haemoglobin A1c74 mmol/mol (20C42)
According to NICE guidelines (CG87, May 2009), what is the most appropriate immediate next step in management to improve his glycaemic control?
A . add exenatide
B . add pioglitazone
C . add sitagliptin
D . increase the dose of gliclazide
E . start insulin treatment
Answer: D
Leave a Reply