Sue Jones, 79 years old, has had type 2 diabetes mellitus for 15 years. She is homebound after a recent stroke and now requires assistance with most of her activities. She has a daytime sitter and a weekly visiting nurse; her family provides care in the evenings and on weekends. The family has moderate means and would like to keep her at home. Sue can communicate effectively: she recognizes all of her family members and you, as her physician.
Her most recent lab tests showed an HbA1c of 9.6; a random blood sugar of 450; triglycerides, 350 mg/dL; HDL, 40; LDL, 110 (calculated); total cholesterol, 220; and non-HDL,180.
Some of her medications were stopped when she was discharged from the hospital 3 weeks ago. She now only takes metformin (2000 mg/d) for her diabetes and no medications for her lipids.
Would you consider more aggressive treatment of her elevated HbA1c? If so, why—and with what medications? What goals would you have for her A1C? Would you do anything to treat her lipids?