MRCP2-3964

MRCP2-3964

A 57-year-old male with a 12-year history of diabetes mellitus presents for his annual review. He is currently taking gliclazide at a dose of 80 mg twice daily. During examination, his pulse is found to be 76 beats per minute regular and his blood pressure is 152/90 mmHg. Fundal examination reveals bilateral dot haemorrhages with scattered hard exudates. He has also experienced a loss of vibration sensation in his ankles, but all pulses are palpable.

The patient’s investigations reveal a serum sodium level of 138 mmol/L (137-144), serum potassium level of 3.8 mmol/L (3.5-4.9), serum urea level of 10.2 mmol/L (2.5-7.5), serum creatinine level of 160 µmol/L (60-110), glucose level of 12.1 mmol/L (3.0-6.0), HbA1c level of 9.5% (3.8-6.4), cholesterol level of 5.5 mmol/L (<5.2), and triglycerides level of 2.8 mmol/L (0.45-1.69). What measures would you take to improve this patient’s prognosis?