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Canadian Pharmacist Qualifying Exam Practice · Question

A 60-year-old male with type 2 diabetes, controlled on metformin 1000 mg BID, presents with a new diagnosis of Stage 3 chronic kidney disease (eGFR 40 mL/min/1.73m²). His A1C is 7.2%. What is the most appropriate action regarding his metformin therapy?

According to Diabetes Canada guidelines, if eGFR is 30-44 mL/min/1.73m², metformin dose should not exceed 1000 mg daily (e.g., 500 mg BID). His current dose of

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Question: A 60-year-old male with type 2 diabetes, controlled on metformin 1000 mg BID, presents with a new diagnosis of Stage 3 chronic kidney disease (eGFR 40 mL/min/1.73m²). His A1C is 7.2%. What is the most appropriate action regarding his metformin therapy?

Answer options:

  • Discontinue metformin immediately. ✅ Reduce metformin dose to 500 mg BID.
  • No change is required, continue 1000 mg BID.
  • Add a SGLT2 inhibitor to lower A1C further.

Correct answer: Reduce metformin dose to 500 mg BID.

Explanation: According to Diabetes Canada guidelines, if eGFR is 30-44 mL/min/1.73m², metformin dose should not exceed 1000 mg daily (e.g., 500 mg BID). His current dose of 2000 mg daily needs to be reduced.

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