Final answer:
For a 55-year-old obese woman with poorly controlled type 2 diabetes and an A1c of 9%, treatment intensification is required. This could include additional or alternative medications, insulin therapy, and emphasizing lifestyle changes such as weight loss and increased physical activity. Frequent blood glucose monitoring and a personalized approach based on pharmacogenomics are also crucial to improve her diabetes management.
Step-by-step explanation:
The management of a 55-year-old obese woman with type 2 diabetes mellitus (DM2) who has an elevated A1c of 9% despite being on the highest tolerated doses of metformin and glimepiride should involve a comprehensive approach. Since her A1c level indicates poor control of her diabetes, a change in treatment is necessary. This may include intensifying her diabetes management with additional pharmacotherapy, considering alternative medication options that could include insulin therapy or non-insulin injectables, like GLP-1 receptor agonists, which are effective at lowering A1c and may also aid in weight loss.
Lifestyle modifications such as weight loss, increased physical activity, and dietary changes, which help in increasing insulin sensitivity and lowering blood glucose levels should continue to be emphasized. The benefits of these lifestyle changes, alongside medication management, can be substantial in controlling blood glucose levels and possibly reducing diabetes-related complications.
Owing to the complexity of diabetes treatment and the individual variability in response to medications, it might be beneficial to refer to an endocrinologist or a diabetes specialist for a more tailored treatment plan. It is also important to frequently monitor blood glucose levels to achieve better glycaemic control, aiming to lower her A1c closer to the target, usually below 7%. Pharmacogenomics could also play a role in personalizing her treatment, ensuring that the medications chosen are the most effective with the least side effects for her individual genetic profile.