Last week we had a 56 y/o female patient who worked for the county schools as a bus driver. She has less than a year till retirement and was worried because she might lose her job because of her elevated A1c. She has had diabetes for 12 years and her current diabetes drug regimen was:
Metformin 1000 mg bid
Glimepiride 4 mg bid
Pioglitazone 30 mg qd
Januvia 100mg qd
Invokana 300 mg qd
Her last A1c was 9.8 which was down from 13.1, 11 months earlier. She had had a meeting with her supervisor and was told that if she went on insulin she could no longer drive a bus but if she did not get her A1c down to 7.5 she would not be allowed to drive. We covered some changes to her eating habits and then switched her to a once-a-week GLP-1 analog, as this was the only non-insulin choice we had left. Hopefully this will help her get down to an acceptable range so she can earn her retirement.
It is a shame that her primary care prescriber did not try this class earlier as she may have never gotten that high to begin with.