Endocrine and Metabolicmiddle twist
A 64-year-old man with type 2 diabetes has an HbA1c of 62 mmol/mol (7.8%) despite maximal-dose metformin and attention to diet and activity. He had a myocardial infarction two years ago and now has exertional breathlessness; a recent echocardiogram showed a left ventricular ejection fraction of 38%. His eGFR is 68 mL/min/1.73 m2 and his body mass index is 31 kg/m2. Which one of the following is the most appropriate medication to add?