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A 55-year-old construction worker diagnosed as having type 2 diabetes mellitus 5 years ago, with current glycosylated hemoglobin (HbA1c) level of 7.4% of total hemoglobin, was referred to the diabetes clinic to optimize glycemic control. He was obese and had hypertension, dyslipidemia, and obstructive sleep apnea, but no known cardiovascular disease. He was prescribed metformin, 1000 mg twice daily; sitagliptin, 100 mg daily; glimepiride, 4 mg daily; and NPH insulin, 20 U at bedtime. (To convert HbA1c to a proportion of total hemoglobin, multiply by 0.01.)
Rodriguez-Gutierrez R, Lipska KJ, McCoy RG. Intensive Glycemic Control in Type 2 Diabetes Mellitus—A Balancing Act of Latent Benefit and Avoidable HarmA Teachable Moment. JAMA Intern Med. 2016;176(3):300-301. doi:10.1001/jamainternmed.2015.8320