He is young and should have a target A1c of less than 6.5 and he is at 8.2%, so I want whatever the next agent I give him to give me a fairly robust A1c reduction. I probably wouldn’t add a DPP-4 inhibitor because I might not get the A1c reduction I am looking for. You could add it, but then you would probable need a third drug.
I wouldn’t use a sulfonylurea like glimipride in this case if I didn’t have to because I don’t want to cause hypoglycaemia and weight gain.
You could add a GLP-1 receptor agonist like liraglutide but often times people prefer the oral choice before they go on to injections.
In this case, I would like to add a SGLT-2 inhibitor like empagliflozin. He can loose some weight. His blood pressure is elevated and one would hope that the SGLT-2 would help with that but I would say keep an eye on that because if it doesn’t come down sufficiently with SGLT-2, I would stress that we nee to adequately improve the BP control with other drugs.