A 76-year-old man with a 17-year history of type 2 diabetes mellitus attended for his annual review. Comparison of his retinal screening report with the previous year’s report showed that his visual acuity was unchanged at 6/9 in both eyes. The previous year’s right eye retinal image had been reported as ‘pre-proliferative retinopathy’, whereas this year’s was reported as ‘pre-proliferative retinopathy with maculopathy’.

What is the most appropriate next step?

A 73-year-old man with type 2 diabetes mellitus was reviewed because of deteriorating blood glucose control. He was taking metformin 850 mg twice daily.

On examination, his body mass index was 29 kg/m2 (18–25).

Investigations:

serum creatinine102 µmol/L (60–110)

haemoglobin A1c66 mmol/mol (20–42)

According to the NICE guidelines (CG87, May 2009), what would be the most appropriate additional treatment?

An 18-year-old man with cystic fibrosis was referred to clinic. Over recent months his lung function had deteriorated and he had lost weight. He was being treated for a chest infection at the time of the consultation.

Investigations:

oral glucose tolerance test (75 g):

fasting plasma glucose8.2 mmol/L (3.0–6.0)

2-h plasma glucose13.5 mmol/L (<7.8)

What is the most appropriate management?