A 52-year-old man with type 2 diabetes on metformin has HbA1c 8.9% and eGFR 62 mL/min. He has established atherosclerotic cardiovascular disease. According to current ADA/ESC guidelines, the next medication with the strongest evidence for reducing MACE in this patient is:
- A Glipizide
- B Sitagliptin
- C Empagliflozin ✓
- D Pioglitazone
Correct answer: C. Empagliflozin
Explanation
Empagliflozin (SGLT2 inhibitor) demonstrated a 14% relative risk reduction in MACE and 38% reduction in cardiovascular death in the EMPA-REG OUTCOME trial in patients with T2DM and established ASCVD. Current ADA guidelines recommend an SGLT2 inhibitor or GLP-1 RA with proven cardiovascular benefit as the preferred second agent in patients with established CVD. Sitagliptin was cardiovascularly neutral (TECOS), glipizide has no cardiovascular outcome data, and pioglitazone lacks the robust MACE data that empagliflozin provides.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.