[Expert Solution]: Mr

Mr. Mackie is a 55-year-old man with type 2 diabetes (T2D). Three months ago, he presented to the emergency room with an ischemic stroke and was also diagnosed with T2D during that hospital admission. At that time, Mr. Mackie’s A1C was 7.2%; his goal A1C was recommended to be less than 7%. Glucose-lowing therapy was not initiated, as he wanted to implement behavioral modifications to manage his hyperglycemia. His new A1C in your outpatient clinic today was 6.9%; his other laboratory tests and vitals are otherwise normal, although his body mass index (BMI) is 31 kg/m2. What recommendation do you give the prescriber to optimize his health at this time? A. He should start metformin to help delay the progression of T2D B. He should continue behavioral modifications without starting any glucose-lowering therapy given his A1C is below his goal C. He should start a GLP-1 RA with evidence for cardiovascular benefit despite his controlled glycemic status D. He should start a dipeptidyl peptidase-4 (DPP-4) with evidence for cardiovascular benefit despite his controlled glycemic status