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).


  • 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)



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



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 guidance, how would you support this patient to optimise the therapy options for him?


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