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[摘要]：A 39-year-old man with a 2-year history of type 2 diabetes mellitus presents for care. He has no microvascular or macrovascular complications. His family history is positive for type 2 diabetes and cardiovascular disease in his mother and older brother. On examination, his weight is 99.8 kg (220 lb), with a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 37, and his blood pressure is 125/85 mm Hg. His glycated hemoglobin level is 8.9%, serum creatinine level 1.0 mg per deciliter (88.4 mu mol per liter), low-density lipoprotein (LDL) cholesterol 88 mg per deciliter (2.3 mmol per liter), high-density lipoprotein (HDL) cholesterol 45 mg per deciliter (1.2 mmol per liter), and triglyceride level 130 mg per deciliter (1.5 mmol per liter); he does not have microalbuminuria. His medications include metformin (500 mg twice daily), glipizide (5 mg twice daily), simvastatin (20 mg daily), and lisinopril (10 mg daily). What would you recommend to improve his glycemic control? |
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