QuestionSBA
QuestionChoice
This would be considered when dual therapy with metformin and another oral drug has not continued to control HbA1c to below the person's individually agreed threshold.
10005387
b
Start insulin-based treatment
QuestionChoice
You could consider adding this drug as a second-line. However, NICE guidance suggests as this man has established atherosclerotic cardiovascular disease, an SGLT2 is preferred first.
10005388
c
Add pioglitazone
QuestionChoice
You could consider adding this drug as a second-line. However, NICE guidance suggests as this man has established atherosclerotic cardiovascular disease, an SGLT2 is preferred first.
10005389
d
Add gliclazide
QuestionChoice
Exenatide is a GLP‑1 mimetic. This would only be considered in special circumstances where triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated.
10005390
e
Add Exenatide
QuestionChoice
Dapagliflozin is an oral hypoglycaemic drug of the class SGLT2 inhibitor. NICE recomemnds for adults with type 2 diabetes at any stage after they have started first-line treatment if they have or develop chronic heart failure or established atherosclerotic cardiovascular disease, to offer an SGLT2 inhibitor in addition to current treatment.
10005386
a
Add dapagliflozin
Concept
Chapter
2693
4396
Type 2 Diabetes mellitus
Topic
221
Endocrine
13624
A 62-year-old male visits an advanced nurse practitioner for a review of his type 2 diabetes. He has currently been taking metformin at his maximum tolerated dose for the last 6 months. His latest HbA1c result is 63mmol/mol and his individually agreed aim is 50mmol/mol. He has suffered from stable angina for the last 3 years but is otherwise well.

Which of the following is the best next step in the management of this patient?
a