Michael is a 48-year-old gentleman with T2DM since age of 38. He has background of ischemic heart disease, mixed hyperlipidemia and hypertension. He had a delayed presentation of an inferior myocardial infarction 3 months ago. He is currently treated with Metformin XR 1g twice daily, Sitagliptin 100mg once daily, perindopril 5mg once daily, bisoprolol 2.5mg once daily Atorvastatin 80mg once daily. His most recent labs showed:
Creatinine 1.1mg/dL (97.3umol/L), eGFR 76ml/minute/1.73m2, fasting glucose 145mg/dL (8mmol/L), HbA1C 7.6% (60mmol/mol), Albumin/creatinine 28 mg/g (normal<30mg/g), total cholesterol 150mg/dL (3.9mmol/L), with HDL-C 40mg/dL (1.04mmol/L), NT-pro-BNP 754pg/ml (normal for age <125pg/ml).
His clinic checks showed height 172cm, weight 73kg, BMI 24.7kg/m2, BP 134/82mmHg.
You explain to him that he has sub-optimal diabetes control and a HbA1C <7.0% should be sought.