MKSAP: 56-year-old woman with type 2 diabetes mellitus

Test your medicine knowledge with theĀ MKSAP challenge, in partnership with theĀ American College of Physicians.

A 56-year-old woman presents to the office to discuss management of her type 2 diabetes mellitus. She is unhappy with her recent HbA1c value. She adheres to the maximum dose metformin monotherapy, which she has been taking for 1 year. Additionally, she has been working toward weight reduction without success; however, weight loss remains a top priority for this patient. Medical history is significant for hypertension, dyslipidemia, and recurrent vulvovaginal candidiasis. Family history includes type 2 diabetes in her mother and sister.

On physical examination, vital signs are normal. Central obesity is noted. The remainder of the examination, including retinal examination and diabetic foot examination, is normal.

Laboratory studies show HbA1c value of 7.6% (goal <7.0%) and glomerular filtration rate greater than 60 mL/min/1.73 m2.

According to the Agency for Healthcare Research and Quality, which of the following is the most appropriate add-on therapy to supplement metformin for this patient?

A. Basal insulin
B. Glucagon-like peptide-1 (GLP-1) receptor agonist
C. Sodium-glucose transporter-2 (SGLT2) inhibitor
D. Sulfonylurea
E. Thiazolidinedione

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