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What current evidence-based guidelines would you use to manage the patient’s diabetes?

Patient is a 62-year-old female with Type II Diabetes Mellitus.  The patient states she checks her blood glucose 1 – 2 times monthly fasting in the mornings and reports that her blood glucose is always less than 120. Patient is currently on Metformin 1000mg twice daily and Glipizide 10mg twice daily. He denies blurred vision, neuropathy, foot ulcers, urinary frequency, nocturia, polydipsia or increased fatigue. Lab results today show an HbA1c of 9.8%.

  1. What current evidence-based guidelines would you use to manage the patient’s diabetes?
  2. What medications would you prescribe to treat the Diabetes Mellitus and why did you choose this treatment plan?
  3. With your current treatment plan, how many points would you expect the HbA1c to drop in 3 months on next visit? What is a normal HbA1c level for this patient?
  4. What are the possible side effects of the medications prescribed?
  5. What education would you provide to the patient regarding both the Diabetes and the treatment plan?

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