patient a 47 year old male was diagnosed with Type 2 diabetes 12 months ago and is

 patient, a 47-year-old male was diagnosed with Type 2 diabetes 12 months ago and is currently treated with lifestyle and metformin 1g twice daily. He lives alone, has had a previous myocardial infarction at the time of diabetes diagnosis but no documented evidence of heart failure. He has an HbA1c of 8% (64 mmol/mol), eGFR 70 mL/min/1.73 m² and BMI 33kg/m2. He is also prescribed atorvastatin 80mg, bisoprolol 5mg and ramipril 10mg.    

With reference to published guidelines, consensus documents and evidence discussed during the module:

1. Justify whether you feel his glycaemic control should be intensified at this stage and if so, discuss what glycaemic target you would aim to agree with him and why.

2. List the additional ORAL hypoglycaemic agents you would consider recommending to him.

3. Outline the mode of action, benefits and potential risks of each treatment type to help him decide on additional therapy.

4. If there are therapies which you would not recommend, document these and explain why. 

5. Allowing for joint decision making and based on individualization of therapy, present a detailed case for which drug you finally recommend he take.  Ensure this recommendation is referenced to your chosen guideline/guidance.