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Iris is a 77-year-old lady who has had type 2 diabetes for 20 years. She is currently treated with metformin 1g bd and linagliptin 5mg od along with ramipril 10mg od for blood pressure and atorvastatin 20mg od with ezetimibe 10mg od for her lipids. Her HbA1c is 56mmol/mol and her non-HDL cholesterol is 2.2mmol/L – down 51% from her initial readings. Her blood pressure is 142/88 mmHg.

The general practice nurse notices, however, that her eGFR is 45 ml/min/1.73m2, down from 51 ml/min/1.73m2 two years ago and 49ml/min/1.73m2 last year. Her ACR is 2.5 mg/mol.

What recommendations would you make regarding Iris’s metformin dose?

(Please select 1 option)

Continue metformin at current dose
Reduce dose of metformin
Discontinue metformin
Substitute slow-release metformin

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