Diabetes Management in Older Adults with Cardiovascular Disease

Editor's Note: Please see the associated Expert Analysis on the same topic here.

A 82-year-old male with hypertension, type 2 diabetes, coronary artery disease, chronic kidney disease stage 3 and a prior stroke comes to your office complaining of dizziness, palpitations and confusion occurring every morning for the past week. The symptoms are not related to exertion and resolve after eating breakfast. The patient lives at home and completes his acts of daily living independently, but his family notes memory problems recently. The patient was recently discharged from the hospital where he was treated for a urinary tract infection and urinary retention complicated by acute kidney injury. Due to his worsening kidney function, he was discharged with instructions to stop metformin and begin taking glyburide to manage his diabetes. The patient's finger stick blood glucose in your office was 48. Subsequent lab tests show elevated creatinine with and estimated GFR of 40 and a hemoglobin a1c of 7%.

Regarding optimal medical management of this patient's diabetes, which of the following statements is true?

Show Answer