A 58-year-old woman with type 2 diabetes has an A1c of 8.6% despite metformin. She has a prior myocardial infarction and an eGFR of 76 mL/min/1.73

Question

A 58-year-old woman with type 2 diabetes has an A1c of 8.6% despite metformin. She has a prior myocardial infarction and an eGFR of 76 mL/min/1.73 m2. BMI is 34 kg/m2. She has no hypoglycemia. Which of the following is the most appropriate next step in management?

Accepted Answer

Start a GLP-1 receptor agonist with cardiovascular benefit

Answer

Use sliding-scale insulin before meals

Answer

Stop metformin and prescribe acarbose

Answer

Start basal insulin as first add-on therapy

Answer

Start glyburide

Type 2 diabetes — USMLE Step 3 MCQ

A 58-year-old woman with type 2 diabetes has an A1c of 8.6% despite metformin. She has a prior myocardial infarction and an eGFR of 76 mL/min/1.73 m2. BMI is 34 kg/m2. She has no hypoglycemia. Which of the following is the most appropriate next step in management?