Question 1 discussion what do and NP with A1C high when already medication metfo

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Question 1 discussion what do and NP with A1C high when already medication metformin and life stile change well used and recommended
In your efforts to improve glycemic control in your patient in Type 2 Diabetes Mellitus, you have recommended adopting a healthy lifestyle with diet modifications and exercise. You also decided to begin Metformin 500mg BID at the initial visit where you diagnosed the patient with T2DM. After your 3 month follow-up visit, you determine that your patient’s HgbA1c level is still elevated. What would be your next course of action? Please provide your rationale with evidence that supports your decision.
Replay to discussion 2- replay to this discussion please
Diabetic retinopathy is a sight-threatening late complication of diabetes and remains one of the leading causes of blindness and death among patients with diabetes. It is among Taiwan’s top five leading causes of death (Peng et al., 2019). Additionally, it is an emerging cause of blindness in middle-income countries. Studies show that diabetic retinopathy will be the leading cause of blindness in high-income countries. The prevalence of diabetic retinopathy worldwide is approximately 10.2% among diabetic patients (Eszes et al., 2021). It occurs due to microvascular end organ damage. All patients with diabetes should be screened for retinopathy. Screening for diabetic retinopathy reduces vision loss in patients with diabetes mellitus. Early screening and monitoring are key to preserving vision for patients with diabetes. Individuals with diabetes are usually asymptomatic during the early stages of the disease.
Diabetic retinopathy has an insidious onset. Its asymptomatic nature during the early stages makes it necessary for regular screening. Detection and evaluation of disease severity during early stages allows for early treatment and management. Treatment is less beneficial in reversing diminished visual acuity. Screening recommendations for diabetic retinopathy include screening within five years following diagnosis and then yearly or more if there are signs of eye disease for people with diabetes type 1. Individuals with type 2 diabetes should be screened at diagnosis and then yearly or more frequently if they have signs of eye disease. Additionally, diabetic patients with eye disease should be screened annually (Esez et al., 2021). Therefore, DR screening among diabetic patients is one of the most crucial ways to ensure they get adequate care and promotion.
Please 1 reply to each discussion is with a minimum of 200 words no included the references between 5 years

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