Yes
Insulin is likely to be most effective option, if BMI >35 consider tablet options
Discuss with patient.
If agrees:
- Commence as per insulin initiation pathway
If declines insulin and no contraindications then:
- Consider Sitagliptin and/
- Add Pioglitazone 45mg od and review at 6 weeks.
- If BMI >35 and on maximum tablets consider Exenatide
- Rediscuss insulin if targets not achieved/side effects from other drugs.
If on maximum dual therapy but third/fourth agent contraindicated or patient intolerant then proceed to insulin.
Acarbose remains an option for triple oral therapy if the patient is resistant to going onto insulin.
If on oral hypoglycaemic therapy with 3/4 agents and targets not achieved then proceed to insulin therapy