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Person not achieving tight targets despite triple therapy

Kamlesh Khunti, Leicester General Hospital, UK

The case

Max Oakley, is a 68 years old retired teacher, lives with his wife who is working full time. Mr Oakley has been depressed since retiring and his diet is poor.

He is overweight (BMI 29), he has had type 2 diabetes for 11 years. Currently, he is going to see GP since he is having visual disturbances.

His diabetes medications are Metformin 1g bd, Dapagliflozin 10mg od, and

Trulicity (dulaglutide) once weekly (started 3 months ago).

The HbA1c is 69 mmol/mol (8.5%) and it has increased since last time measured, six months ago, then the HbA1c was 60mmol/mol (7.6%).

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