Test Your Knowledge #506: A 58-year-old woman who has had Type 2 diabetes for 15 years is evaluated at a routine...

A 58-year-old woman who has had Type 2 diabetes for 15 years is evaluated at a routine follow-up examination. She has coexisting hypertension, hyperlipidemia, and background retinopathy but no other known microvascular or macrovascular complications of diabetes. Medications include glimepiride 8 mg/day, metformin 1000 mg twice daily, lisinopril 20 mg/day, hydrochlorothiazide 12.5 mg/day, atorvastatin 20 mg/day, and low-dosage aspirin. She adheres to a meal plan and walks for 30 minutes daily 5 days per week. Her body mass index is 29. Background retinopathy is confirmed. Her hemoglobin A1c value is 8.5% and fasting glucose level is 185 mg/dL (10.27 mmol/L).