A 52-year-old man with type 2 diabetes on metformin 1 g twice daily has HbA1c 8.4%. He has eGFR 48 mL/min/1.73m², UACR 180 mg/g, and established atherosclerotic cardiovascular disease. Which add-on agent provides both cardiovascular and renal outcome benefits supported by dedicated CVOT/renal trials?

• A Sitagliptin
• B Pioglitazone
• C Glimepiride
• D Empagliflozin ✓

Explanation

Empagliflozin (EMPA-REG OUTCOME trial) reduced CV death and hospitalization for heart failure in established ASCVD; the EMPA-KIDNEY trial demonstrated renal protection with eGFR as low as 20 mL/min/1.73m². Sitagliptin (TECOS) showed CV neutrality without renal superiority. Pioglitazone has some CV benefit (PROactive) but causes fluid retention and is avoided with heart failure. Glimepiride has no proven cardiorenal benefit.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.