GLP-1 Agonist Use in a Patient with High Insulin Resistance

Mr. X is a 31-year-old male who has been diagnosed with type 1 diabetes since the age of 14. He has a history of pancreatitis in 2008. He came to the clinic a year ago at age 30 with A1C = 9.1%, weight = 290.40 lbs and body mass index (BMI) = 36.79 kg/m2. He was on an insulin pump with 138 units basal and 22 units pre-prandial dose. He was started on metformin 1000 mg twice a day and dapaglifozin 10 mg daily. His insulin was switched to U-500 25 units twice a day which was increased to 50 units twice a day due to his high insulin resistance. He was also started on atorvastatin 20 mg daily, fenofibrate 54 mg daily and pioglitazone 15 mg daily for high triglycerides.

Mr. X is here today for a follow up visit. His A1C is 6.5%, weight 285 lbs, triglyceride 531 mg/dL, C-peptide 0.85 nmol/L, and BMI 33.8 kg/m2.

He states adherence to his medication regimen. He is still taking 50 units of U-500 insulin twice a day for his glycemic control due to his high insulin requirement. Due to his C-peptide levels, he is considered to have type 2 diabetes mellitus.

According to the 2017 AACE/ACE consensus statement on the comprehensive type 2 diabetes management, which one of the following recommendations for the use of GLP-1 agonist could be considered for this patient?

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