MRCP2-1592

MRCP2-1592

A 50-year-old male presents to his general practitioner with complaints of lethargy and weight loss over the past three months. He has a history of diabetes mellitus for the past six years and is currently taking gliclazide 160 mg daily and metformin 1 g twice daily. On examination, his BMI is 25.6 kg/m2, pulse is 88 beats per minute, and blood pressure is 164/102 mmHg. Fundal examination reveals dot haemorrhages in the temporal retina of both eyes with occasional hard exudates. Loss of position and vibration sensation are noted to the mid tibia bilaterally.

Further investigations reveal a haemoglobin level of 140 g/L, white cell count of 4.8 ×109/L, platelets of 195 ×109/L, serum sodium of 137 mmol/L, serum potassium of 4.6 mmol/L, serum urea of 16.7 mmol/L, serum creatinine of 220 µmol/L, HbA1c of 78 mmol/mol (9.3%), and urinalysis showing protein++ and blood+.

What is the most appropriate therapeutic strategy for this patient?