Yes
Discuss with patient and reaffirm concordance with all aspects of treatment/lifestyle change.
Add glicazide or consider Sitgliptin 100mg if BMI>35.
Uptitrate glicazide weekly if FCG > 10.0 mmol/L > 2 out of 3 occasions.
Uptitrate fortnightly if FCH in range 6.0-9.9 mmol/L > 2 out o3 occasions.
Stop up titration if target achieved. At all stages review concordance with all measures for glycaemic control.
Stop up titration if target achieved. At all stages review concordance with all measures for glycaemic control.
Dosing schedule:
- Glicazide 80mg am, 80mg pm
- Glicazide 160mg am, 80mg pm
- Glicazide 160mg am, 160mg pm
If on maximum dual therapy but thrid/fourth agent contraindicated or patient intolerant then proceed to insulin.
Acarbose remains an options for triple oral therpay if patient is resistant to going onto insulin.
If on hypoglycaemic therapy with 3 agents and targets not achieved then proceed to insulin therapy.