MRCP2-1316

MRCP2-1316

A 55-year-old man who drives a heavy goods vehicle presents to the diabetes clinic for evaluation. He is currently taking metformin 1g BD and gliclazide 160 mg BD for his diabetes. His blood sugar levels have been gradually increasing over the past few months and his latest HbA1c is 72 mmol/mol. He has gained 5kg in weight over the last 12 weeks, which he attributes to his work as a lorry driver. On examination, his blood pressure is 155/88 mmHg, pulse is regular at 75 beats per minute. His abdomen is soft and non-tender, and his body mass index is 37 kg/m².

Lab results:

Na+ 140 mmol/l
K+ 5.0 mmol/l
Urea 7.1 mmol/l
Creatinine 110 µmol/l

What is the most appropriate next step?