Young person with need for aggressive management for legacy effect- not reaching targets, time for another therapy

The case

Paul Jones, a 53-years old man, who works full time as a clerk in an office is having his annual review with the practice nurse.

Paul is divorced and lives with grown-up children. He does not have a healthy lifestyle, he smokes, dose not exercise and his diet is poor. Paul has hypertension, dyslipidaemia, he is obese (BMI 35) and he was diagnosed with type 2 diabetes two years ago.

Paul is taking Metformin 1g bd, Candersartan 8 mg, Atorvastatin 20 mg. His HbA1c is 63 mmol/mol (7.9%).

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