Diabetes Review

Current Medications

• metformin (Diabex) 1,000 mg PO BD
• empagliflozin (Jardiance) 10 mg PO OD
• perindopril (Coversyl) 5 mg PO OD
• atorvastatin (Lipitor) 40 mg PO ON

Recent Progress

• T2DM review. HbA1c improved from 8.1 % (65 mmol/mol) to 7.2 % (55 mmol/mol) over past 3 months following initiation of empagliflozin. Home fasting BSLs averaging 6.5–7.8 mmol/L. No hypoglycaemic episodes or genitourinary symptoms. Weight down 2.5 kg (current BMI 29.2 kg/m²). BP 128/78 mmHg. Foot exam: pedal pulses intact, normal 10 g monofilament sensation bilaterally.

Management Plan

1. Continue current medications
   • metformin (Diabex) 1,000 mg PO BD
   • empagliflozin (Jardiance) 10 mg PO OD
   • perindopril (Coversyl) 5 mg PO OD
   • atorvastatin (Lipitor) 40 mg PO ON
2. Monitoring
   • Repeat fasting bloods (HbA1c, UEC, eGFR, LFTs, fasting lipids) and spot urine ACR in 3 months. Continue home fasting BSL checks twice weekly.
3. Follow-up
   • Review in 3 months with pathology results to complete annual cycle of care.
4. Lifestyle recommendations
   • Maintain low-GI, portion-controlled diet.
   • Continue brisk walking 30 mins 5 days/week.
   • Limit alcohol to ≤ 2 standard drinks/day with at least 2 alcohol-free days/week.
5. Education
   • Discussed SGLT2i sick day management (withhold empagliflozin during acute dehydrating illness or fasting for procedures).
   • Reinforced daily foot care and inspection.
   • Reviewed perineal hygiene to prevent mycotic infections.
6. Complications screening
   • Optometry review scheduled next month for dilated diabetic retinal photography.
   • Podiatry referral provided via GP Management Plan (GPMP) for annual comprehensive foot assessment.
   • Urine ACR requested for nephropathy screening.
7. Adjustments
   • If repeat HbA1c remains > 7.0 % (53 mmol/mol) in 3 months, uptitrate empagliflozin to 25 mg PO OD or consider adding a GLP-1 RA.