A 33-year-old woman comes to the clinic for follow-up management of type 2 diabetes mellitus and high blood sugar readings. She was diagnosed with diabetes 2 years ago and started taking metformin. She has been taking her medication regularly and been eating a good diet and regularly exercising. Her hemoglobin A1c level decreased from 8.0% to 7.5% over the last 12 months. She has been frustrated over her hemoglobin A1c level and wants greater control over her blood sugar.
Her medical history is unremarkable, and she takes no other medications.
On physical examination, blood pressure is 134/70 mm Hg and pulse rate is 84/min. BMI is 30. The remainder of the examination is normal.
Which of the following treatments is most likely to achieve the greatest reduction in hemoglobin A1c level?
A. Metformin only
B. Sulfonylurea only
C. Dipeptidyl peptidase-IV only
D. Metformin and sodium glucose transporter 2 inhibitor
Reference:
Qaseem A, Barry MJ, Humphrey LL, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Oral pharmacologic treatment of type 2 diabetes mellitus: a Clinical Practice Guideline Update from the American College of Physicians. Ann Intern Med. 2017;166:279-290. PMID: 28055075