I have a type 2 diabetic with an A1c of 63mmol/mol. They are Asian descent. Curr

The appropriate next step in management for a patient with type 2 diabetes of Asian descent, an HbA1c of 63 mmol/mol, currently on maximum tolerated doses of metformin and linagliptin, is to consider adding a third glucose-lowering agent. This could be a sodium–glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist, depending on the patient's individual clinical circumstances, preferences, and comorbidities.

Given the patient's ethnicity (Asian descent), the BMI threshold for considering GLP-1 receptor agonists is adjusted lower than the standard 35 kg/m2, so if the patient has a BMI below 35 kg/m2 but would benefit from weight loss or has contraindications to insulin, a GLP-1 receptor agonist may be appropriate.

If triple oral therapy is not effective or tolerated, or if the patient has significant hyperglycaemia symptoms, insulin therapy should be considered next.