Yes

Discuss with patient and reaffirm concordance with all aspects of treatment/lifestyle change.

Maximising tablet options and weight loss is the best option however discuss the options available:

Add glicazide 40mg bd

Uptitrate glicazide weekly in FCG > 10.0 mmol/L > 2 out o3 occasions.

Uptitrate fortnightly in FCG in range 6.0-9.9 mmol/L > 2 out of 3 occasions.
Stop up titration if target achieved.
At all stages review concordance with all measures for glycaemic control.

Dosing schedule:
- Gliclazide 80mg am, 80mg pm
- Glicazide 160mg am, 80mg pm
- Glicazide 160mg am, 160mg pm
If patient not on Sitagliptin then add in *(discussion with specilaist team).
If BMI > 35 on maximum tolerated tablets consider exenatide*. (will need specialist referral)
Consider weight loss pathway, with the possibility of bariatric surgery * if well and under 60 years of age.
Consider night time insulin if targets are not met on maximum oral treatment.

If patient chooses insulin then follow insulin pathway.

If on maximum tablets and target not met follow insulin pathway

Acarbose remains an option for triple/quadruple oral therapy

If on oral hypoglycaemic therapy with 3/4 agents and targets not achieved then proceed to insulin therapy.

Options