Renal failure complications in a man with type 2 diabetes

John, aged 64 years, was diagnosed with type 2 diabetes six years ago. This was discovered when he noted worsening vision and saw an optometrist who had suggested he might have early cataracts. He now wears intraocular lenses bilaterally and has recently developed nonproliferative diabetic retinopathy. John has been overweight most of his life and has a sedentary job. His diabetes is managed with metformin extended release 1 g twice daily and he is also taking irbesartan 150 mg daily for hypertension, which was also diagnosed six years ago. He is new to the area and has come to see you, his GP, for a check up. This is the first time you have seen him.

Picture credit: © iStockphoto/geniebird. Model used for illustrative purposes only.