A 64 year-old Caucasian woman with an 11-year history of type 2 diabetes is referred to you for further management. She is currently taking metformin 1000 mg bid, rosuvastatin 10 mg daily, and irbesartan 150 mg daily. Menopause was at age 47, and she has never taken any estrogen replacement therapy. Her examination is significant for a body mass index (BMI) of 32 kg/m2 (normal, 18.5 to 24.9 kg/m2), a blood pressure (BP) of 142/86 mm Hg, and decreased vibratory sensation in her feet with absent Achilles reflexes and pedal pulses. The patient does not have lower extremity edema.
Glycated hemoglobin (A1c): 8.2% (normal, <5.7%)
Serum creatinine: 1.8 mg/dl (normal, 0.5 to 1.1 mg/dL)
Estimated glomerular filtration rate (eGFR): 28 mL/min/1.73 m2 (normal, >90 mL/min/1.73 m2)
Urine microalbumin/creatinine ratio of 62 mg/g (normal, <30 mg/g)
Low density lipoprotein (LDL) cholesterol: 93 mg/dL (normal, <100 mg/dL)