5th May 2024

A 55-year-old woman with type 2 diabetes presents with fatigue, increased thirst, and a recent history of unexplained weight loss.

A 55-year-old woman with type 2 diabetes presents with fatigue, increased thirst, and a recent history of unexplained weight loss. She has been managing her diabetes with diet and metformin. Her blood pressure is 138/85 mmHg. Laboratory tests show a serum creatinine level of 1.6 mg/dL, eGFR of 45 mL/min/1.73 m², and a urinary albumin-to-creatinine ratio of 300 mg/g. Her HbA1c is 8.2%. She has no signs of fluid overload or other complications.

Which is the most appropriate next step in management?