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A 38-year-old Caucasian male presents to your office reporting symptoms of fatigue, thirst, and weight loss. He has not been to a physician since his late 20s. Your physical examination shows high blood pressure (150/96 mmHg) and a BMI (body-mass index) of 36 kg/m2. There is a family history of cardiovascular disease, although the patient himself reports having no personal history of cardiac symptoms or cardiovascular events.
There is almost no other disease as pervasive as type 2 diabetes, a disease that has touched almost every family in America. Although there was a time when we had limited management tools, we now have ten classes of medications plus many kinds of insulin available as options. The result is a choice of many treatment combinations, which, however welcome, can also be overwhelming for the practicing physician. With so many choices it becomes very hard to decide what comes after metformin.