No
Maximising tablet options and weight loss is the best option however discuss the options available:
-
Insulin as per insulin initiation pathway . Usually night time long acting ( insulatard)
-
Addition of Sitagliptin 100mg followed by/or Pioglitazone 15mg od if no contraindication (consider fracture risk , do not use > 10% www.shef.ac.uk/FRAX/ to caculate)
-
If BMI > 35 on maximum tablets consider exenatide.
-
Consider weight loss pathway, with the possibility of bariatric surgery * if well and under 60 years of age.
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 30 mg then 45mg od if targets not met.
If on maximum tablets and target not met follow insulin pathway
Acarbose remains an option for triple/quadruple oral therapy .