What additional therapies can be added if metformin monotherapy is ineffective?
A 55-year-old African American female presents to clinic as a new patient. She has not seen a
physician in many years and would like a general health checkup. The patient is not treated for
any chronic health problems. However, her mother had type 2 diabetes, and she would like to be
screened.
Physical examination is unremarkable except for weight of 180 lb (81.8 kg; height 165 cm, BMI
30.3 kg/m2). The patient has multiple risk factors for type 2 diabetes including age, ethnicity,
and family history that justify screening. Since the patient is not fasting, hemoglobin A1c
(HbA1c) is measured and found to be elevated at 6.8%. Morning fasting plasma glucose is 145
mg/dL.
Who should be screened for type 2 diabetes mellitus?
2. How is type 2 diabetes initially managed?
3. What regular screening is necessary for type 2 diabetes patients?
4. What additional therapies can be added if metformin monotherapy is ineffective?
5. What is the next step in management for patients with progressively worsening glycemic
control despite multiple oral medications or glucagon-like peptide-1 (GLP-1) analog therapy?
Answer preview What additional therapies can be added if metformin monotherapy is ineffective?
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