A 57-year-old man with a history of type 2 diabetes mellitus and chronic heart failure is reviewed in the diabetes clinic. His current medication list is as follows:
metformin 1g bd
gliclazide 160mg bd
ramipril 10mg od
bisoprolol 5mg od
furosemide 40mg od
simvastatin 20mg on
His annual bloods show the following:
Na+ 140 mmol/l
K+ 3.9 mmol/l
Urea 5.2 mmol/l
Creatinine 78 µmol/l
HbA1c 7.7% (61 mmol/mol)
Total cholesterol 4.2 mmol/l
HDL cholesterol 1.1 mmol/l
Blood pressure today is 124/78 mmHg and body mass index is 29 kg/m².
What is the most appropriate action with regards to his anti-diabetic medication?
No changes to medication
Exenatide
Repaglinide
Pioglitazone
Sitagliptin
Pioglitazone should be avoided in this man due to his history of heart failure. He would also not fit the NICE criteria for exenatide.
A HbA1c of 7.7% (61 mmol/mol) should be improved if possible. Sitagliptin may be added to metformin and gliclazide.