No
Insulin is likely to be the most effective option but discuss the two options available:
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Insulin as per insulin initiation pathway
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Addition of *Sitagliptin 100mg followed by/or Pioglitazone 30mg od if no contraindication( *Will need discussion with specialist team)
If patient chooses insulin then follow insulin pathway.
If patient chooses Sitagliptin/Pioglitazone then review in 6 weeks and add in Pioglitazone* or increase to 45 mg od if targets not met, if patient unwilling to have insulin.
If on maximum triple therapy proceed to insulin
Acarbose remains an option for triple oral therapy if the patient is resistant to going onto insulin but chances of achieving targets would be slim at this stage.
If on oral hypoglycaemic therapy with 3 agents and targets not achieved then proceed to insulin therapy.