A 50-year-old man with a 9-year history of type 2 diabetes mellitus presented with excessive tiredness. His partner said
Posted: Fri Aug 26, 2022 10:02 am
A 50-year-old man with a 9-year history of type 2 diabetes mellitus presented with excessive tiredness. His partner said that he snored excessively. His haemoglobin A1c was usually between 64 and 75 mmol/mol (2042). He was taking glimepiride 4 mg daily and orlistat. He was intolerant of metformin.On examination, he had reduced sensation to a 10-g monofilament, and extensive background diabetic retinal changes. His Epworth sleepiness score was 13/24. His body mass index was 36 kg/m2 (1825) despite compliance with orlistat.According to the NICE guidelines (CG87, May 2009), what is the most appropriate treatment?
A. acarbose
B. bariatric surgery
C. basal bolus insulin
D. dipeptidyl peptidase-4 inhibitor E. glucagon-like peptide-1 agonist
A. acarbose
B. bariatric surgery
C. basal bolus insulin
D. dipeptidyl peptidase-4 inhibitor E. glucagon-like peptide-1 agonist