No
Discuss the options available:
1. Insulin as per insulin initiation pathway
2. Addition of Pioglitazone 30mg od if no contraindication.
3. Consider Sitagliptin* 100mg od if glitazones counterindicated.
4. If on maximum tolerated oral therapy and targets not met consider Exenatide* if BMI >35 (*specialist referral required).
If patient chooses insulin then follow insulin pathway.
If patient chooses Pioglitazone then review in 6 weeks and increase to 45mg od if targets not met.
If on maximum dual therapy therapy but third/fourth agent contraindicated or patient intolerant then proceed to insulin or ?Exenatide.
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 or Exenatide if BMI>35.