Assessing the Use of Canagliflozin

RM is a 58-year-old Caucasian male with type 2 diabetes, chronic kidney disease (CKD), and hypertension who presents to his family physician for his annual wellness exam.

Height: 69 inches; Weight: 212 pounds, Blood pressure 128/78; Pulse: 66; BMI: 31.4 kg/m2 Past medical history: type 2 diabetes (12 years), stage 3B chronic kidney disease, and hypertension (for the past 10 years).

Family history: mother had diabetes and hypertension.

Social history: denies alcohol and tobacco use.

Medications: lisinopril 40 mg PO daily, HCTZ 25 mg PO daily, amlodipine 10 mg PO daily, metformin 500 mg PO BID, rosuvastatin 40 mg PO daily.

Today's labs: A1c = 6.9%, eGFR = 38 mL/min/1.73 m2, UACR = 927 mg/g
lipid panel: TC= 152 mg/dL, TG= 198 mg/dL, HDL-C = 44 mg/dL, LDL-C= 68 mg/dL

RM's physician reemphasizes lifestyle modifications such as avoiding foods high in starch and sugar as well as increasing exercise as tolerated. She is willing to initiate a medication to help reduce progression of kidney disease.

According to the ADA Standards of Medical Care in Diabetes 2020, which one of the following choices is the best option to reduce progression of kidney disease?

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