Question

A 62-year-old First Nations man living in a remote Northern community presents to a nursing station for routine diabetes follow-up. He has longstanding type 2 diabetes and stage 3 chronic kidney disease. Recent labs show HbA1c 8.4%, eGFR 45 mL/min/1.73 m² and urinary albumin-creatinine ratio 35 mg/mmol. According to Diabetes Canada and principles of Indigenous health equity, what is the most appropriate next step?

Accepted Answer

Initiate or uptitrate an ACE inhibitor or ARB and collaborate with community resources to address nutrition and access barriers.

Answer

Focus solely on intensifying insulin therapy and ignore social determinants of health.

Answer

Stop all renin-angiotensin system blockade because of reduced eGFR and manage with lifestyle alone.

Answer

Arrange yearly follow-up only, as tighter control has no benefit in Indigenous populations.

Answer

Advise relocation to an urban centre as the only means to improve care.

Practice question