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HardEndocrinologyType 2 diabetes with albuminuric CKD in Indigenous patientca-mccqe1ca-ccfpca-rcpsc-im

A 63-year-old First Nations woman living on-reserve presents to a rural clinic for follow-up of type 2 diabetes diagnosed 5 years ago. Her HbA1c is 8.4% despite metformin at maximum tolerated dose. She has microalbuminuria but no established cardiovascular disease. According to Diabetes Canada and with attention to Indigenous health equity, what is the most appropriate next pharmacologic step?

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