I recommend coming to a mutual agreement with the patient to switch from gliclazide to liraglutide od in view of its cardioprotective properties, but also to aid weight loss and minimize the risk of future hypoglycemia. While an SGLT2 inhibitor could be considered it should not be initiated due to this patient’s impaired renal function (all currently available SGLT2 inhibitors can only be initiated if eGFR is greater than 60 mL/min per 1.73 m2 according to SIGN 154 ).
Prescribing notes: Empagliflozin and canagliflozin can only be initiated if eGFR is over 60 mL/min per 1.73 m2. However, if eGFR subsequently falls below 60 mL/min per 1.73 m2, empagliflozin can be continued at 10 mg od and canagliflozin at 100 mg od. However, both empagliflozin and canagliflozin must be stopped if eGFR drops below 45 mL/min per 1.73 m2 [1,2].