Quadruple Non-Insulin Therapy for Advanced Type 2 Diabetes Mellitus With Cognitive Impairment: A Case Report.

Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder that often requires treatment intensification over time. In complex patients with multiple comorbidities and cognitive impairment, therapeutic decisions must balance glycemic control with safety and feasibility. We present a 59-year-old male with long-standing T2DM, marked body weight fluctuations, and emerging neurocognitive decline. Baseline glycated hemoglobin (HbA1c) was 9.4%, with progressive improvement to 7.1% under quadruple non-insulin therapy consisting of metformin, sitagliptin, glimepiride, and semaglutide. Insulin therapy was avoided due to cognitive impairment and a high risk of dosing errors. Sustained glycemic control was achieved without severe hypoglycemia. This case highlights the importance of individualized, multidisciplinary management in advanced T2DM and demonstrates that non-insulin strategies may be a viable and safe alternative in selected high-risk patients.