Had Helen’s HbA1c level been closer to 64mmol/mol, the reduction in gliclazide dose could have been less. If it had been over 65mmol/mol, dose reduction would have been considered based on the stability of her HbA1c level over 12 months.
A dose reduction may not be appropriate if the person monitors their blood glucose level well, although increased blood glucose monitoring is encouraged in all situations. Ideally, 24-hour, continuous blood glucose monitoring for two weeks would be a good safeguard, if affordable.
After four weeks, Helen reports that her blood glucose level has increased to 7–8mmol/L in the morning and is still approximately 9mmol/L in the evening. Her empagliflozin is increased to 25mg/day.
After a further four weeks, Helen’s blood glucose level has returned to 6–7mmol/L in the morning, and it has reduced to 6–8mmol/L before dinner. Three months after starting empagliflozin, her HbA1c level is 51mmol/mol, albumin:creatinine ratio is reduced to 6.7mg/mmol, and she reports 1kg in weight loss.