Mr. Winters, a 67 year old construction worker has Type II diabetes; he has been taking Metformin for over 5 years. At a recent routine quarterly appointment, the APN notices that his weight and his serum creatinine are elevated. In addition, Mr Winters is complaining of indigestion and bloating. He claims to have increased his intake of pasta and other carbs to help his indigestion improve

In choosing the best first line drug therapy for older adults with Type II diabetes, what are three important things to consider?

 What is the APN concerned about in the current assessment above and what drug change might be appropriate?