Mrs. Mahem is a 68-year-old patient with a 25-year history of type 2 diabetes mellitus. In the past year, her A1c remains at around 8.5% with the use of the following medications: metformin, sitagliptin, and canagliflozin, at optimized doses and with adherence.  She states, “ I haven’t changed the way I eat and I walk about ½ h a day, just like I have for years”. Additional health issues include HTN and dyslipidemia, treated with medications and at therapeutic goal, and obesity with a BMI= 33. Her eGFR is 65. 

Which of the following is the most appropriate next step in the pharmacologic management of her diabetes?  

A. Add glyburide to enhance glycemic control.

B. Consider discontinuing metformin due to age and renal function.

C. Advise that her glycemic control is adequate for an older adult. 

D. Prescribe semaglutide to help her achieve A1c goal.  

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