MSFinals-1073

MSFinals-1073

A 65-year-old woman is referred to the Diabetes Clinic with a new diagnosis of type 2 diabetes mellitus. She has a body mass index (BMI) of 34 kg/m2. Her finger-prick blood glucose test is 9 mmol/l. She has a past history of ischaemic heart disease and chronic kidney disease. Her medications include ramipril 10 mg daily, atorvastatin 40 mg, aspirin 75 mg and bisoprolol 5 mg. Her laboratory test results are as follows:
Investigation Result Normal range
HbA1C 61 mmol/mol < 53 mmol/mol (<7.0%)
Creatinine 178 µmol/l 50–120 µmol/l
Glomerular filtration rate (GFR) 26 ml/min > 90 ml/min
Which of the following drugs would be the most appropriate to manage this patient’s diabetes?