A 51-year-old male has been living with Type 2 diabetes for eight years. He is a non-smoker, drinking less than 14 units of alcohol per week. He has no personal or family history of major adverse atherosclerotic cardiovascular events. There is no evidence of diabetic retinopathy although he has reduced sensation to monofilament testing in his left great toe.

Recent investigations show the following:

BP: 157/94 mm Hg (confirmed by home blood pressure monitoring)
BMI: 33 kg/m2
Waist circumference: 42inches (106cm).
Investigations:

Urinary Albumin/creatinine ratio (uACR): 38 mg/mmol (334 mg/g)
Estimated glomerular filtration rate: 55 mL/min/1.73 m2
HbA1c: 71.6 mmol/mol (8.7%)
Total cholesterol: 4.2 mmol/l (162.4 mg/dL)
LDL cholesterol 3.3 mmol/L (130 mg/dL)
Triglycerides (TG): 1.75 mmol/l (155 mg/dL)

Medication:

Metformin 500mg bd
Ramipril 2.5mg daily
Atorvastatin 20mg daily

Questions:

Having considered this patient’s results answer the following questions:

As a primary care health care professional how will you establish, categorise and manage this man, to maximise his renal status?
Ideally, and referring to current evidence-based guidances, how would you support this patient to optimise the therapy options for him?

Key regulations

Word Limit: 2,000 words (+/- 10%)
There is an opportunity to submit a draft essay for Modules 1-3 only and feedback is issued
References should be done consistently using a standard format (Harvard or Vancouver)
Late submissions, without an approved extension, may attract a penalty.
2 attempts are allowed for each assessment (a main attempt and repeat attempt