🏥 USMLE Exam Prep

A 58-year-old female with a 5-year history of Type 2 Diabetes Mellitus, managed with metformin, presents for a follow-up. Her last HbA1c was 8.2%. She reports occasional blurry vision and numbness in her feet. Her current BMI is 31 kg/m². Which of the following is the most appropriate next step in her diabetes management?

A Discontinue metformin and start insulin therapy.
B Add a dipeptidyl peptidase-4 (DPP-4) inhibitor to her current regimen.
C Initiate a sodium-glucose cotransporter-2 (SGLT2) inhibitor.
D Increase the dose of metformin to the maximum allowable.

✓ Correct Answer: Option C

An SGLT2 inhibitor is appropriate given her uncontrolled HbA1c, high BMI, and potential for microvascular complications, offering cardiovascular and renal benefits beyond glycemic control.

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