A patient with type 2 diabetes mellitus takes metformin (Glucophage)1000 mg twice daily and glyburide (Micronase)12 mg daily.At an annual physical examination,the BMI is 29 and hemoglobin A₁c is 7.3%.The NP should:

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The target hemoglobin A₁c goal for adults is less than 7%.Insulin therapy is indicated if maximum doses of two oral antidiabetic drugs are not effective.This patient is taking the maximum recommended doses of metformin and glyburide.Colesevelam does not decrease hemoglobin A₁c.Adding a third oral antidiabetic agent is not recommended.A weight loss program may be a part of this patient's treatment,but insulin is necessary to maintain glycemic control.

A Patient with Type 2 Diabetes Mellitus Takes Metformin (Glucophage)1000