29th May 2025

A 50-year-old female with type 2 diabetes mellitus presents with worsening renal function and an albumin-creatinine ratio (ACR) of 40mg/mmol.

A 50-year-old female with type 2 diabetes mellitus presents with worsening renal function and an albumin-creatinine ratio (ACR) of 40mg/mmol. Her estimated glomerular filtration rate (eGFR) is 29 ml/min/1.73m2. He currently injects insulin glargine once daily to control his diabetes and ramipril for his DKD. He has a BMI of 38 kg/m2 and his most recent HbA1c is 53 mmol/L. What is the most appropriate next step in the management of this patient with DKD?

Select the SINGLE most appropriate option from the list below. Select ONE option only.