Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

After a patient presents with nearly full medications following starting metformin, what is the best next step?

1. Confront the man about his poor medication management.

2. Telephone the pharmacy to verify the last refill date.

3. Change to the extended release formulation of metformin.

4. Review self-monitored blood glucose log.

The correct answer is: Telephone the pharmacy to verify the last refill date.

Verifying the last refill date with the pharmacy is a critical step in understanding a patient's medication adherence. By checking the refill history of metformin, the healthcare provider can gather important information about whether the patient is picking up their medication regularly and taking it as prescribed. If the medication is being consistently refilled and the patient is still not improving, this might suggest issues such as side effects, lack of understanding of how to take the medication properly, or that the current dosage is inadequate. This information can help inform the next steps in management, including whether to provide further education about the medication or consider alternative therapies. In contrast, confronting the patient could create defensiveness and discourage open communication, while changing to an extended release formulation might not address the underlying issue of adherence. Reviewing the blood glucose log is also useful, but without first verifying medication use, it might not provide a complete picture of the patient's management. Therefore, confirming the refill history is the most appropriate and informative first step in addressing the situation.