Presentation

You are a final year medical student on a General Practice attachment. Dr. McPhee is the supervising doctor.

Mr. Green, a 56-year-old man, attends the clinic that morning. He complains of nocturia and increased thirst. You take a look at the medical notes; Mr. Green has a history of hypertension, well-controlled on ramipril. An echocardiogram performed last year showed a normal left ventricular ejection fraction of 60% (normal >55%), with no structural heart disease. Physical examination is unremarkable. His BMI is 27 kg/m². You decide to perform a urinalysis, which shows 1+ glucose, negative for blood, ketones, and proteins; no inflammatory cells, casts or crystals on urine microscopy.

You decide to check Mr. Green's fasting blood glucose level and HbA1c before deciding on the best course of action. Laboratory results show a fasting blood glucose level of 152 mg/dL and 148 mg/dL (NR <126 mg/dL). His HbA1c is 7.8%. eGFR is 78 mL/min/1.73 m²; AST/ALT are within normal limits.

Which drug should be prescribed for Mr. Green?