Question

A 72-year-old man with long-standing poorly controlled type 2 diabetes and chronic kidney disease (eGFR 35 mL/min/1.73 m²) presents with progressive fatigue and ankle oedema. His HbA1c is 6.8% on basal insulin and a sulfonylurea. According to Diabetes Canada and nephrology guidance, which antihyperglycaemic adjustment is most appropriate?

Accepted Answer

Stop the sulfonylurea and consider reducing insulin dose to avoid hypoglycaemia

Answer

Add an SGLT2 inhibitor to intensify glycaemic control

Answer

Increase the sulfonylurea dose to lower HbA1c further

Answer

Add metformin to improve insulin sensitivity

Answer

Aim for HbA1c <6.0% by intensifying insulin therapy

Practice question