A 82-year-old man with long-standing type 2 diabetes (HbA1c 72 mmol/mol) is seen in the diabetes clinic. He has a CFS of 5 and multiple comorbidities ...

Question

A 82-year-old man with long-standing type 2 diabetes (HbA1c 72 mmol/mol) is seen in the diabetes clinic. He has a CFS of 5 and multiple comorbidities including CKD stage 3b, ischaemic heart disease, and diabetic retinopathy. He is on Metformin 500 mg BD and Gliclazide 160 mg BD. He has had two episodes of symptomatic hypoglycaemia in the past month. According to NICE and considering frailty, what is the MOST appropriate change?

Accepted Answer

Reduce Gliclazide dose and relax the HbA1c target to 58-64 mmol/mol given frailty and hypoglycaemia risk

Answer

Increase Gliclazide to 240 mg BD to achieve tighter control

Answer

Add insulin glargine to intensify therapy

Answer

Switch Metformin to Pioglitazone

Answer

Continue current regimen and advise more frequent blood glucose monitoring

uk-dgm MCQ (SBA): Glycaemic Targets in Frail Older People