A 58-year-old man with type 2 diabetes on metformin presents with HbA1c of 9.2%. He has established atherosclerotic cardiovascular disease (ASCVD). Which add-on agent is recommended by the 2023 ADA Standards of Care as the preferred second agent specifically because it reduces major adverse cardiovascular events (MACE) independent of glycemic control?
- A Sitagliptin
- B Empagliflozin ✓
- C Acarbose
- D Glimepiride
Correct answer: B. Empagliflozin
Explanation
SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin) and GLP-1 receptor agonists with proven CV benefit are recommended by the 2023 ADA guidelines as preferred add-on agents in patients with established ASCVD, heart failure, or CKD, regardless of HbA1c. Empagliflozin demonstrated MACE reduction in the EMPA-REG OUTCOME trial. Sitagliptin (TECOS trial) was CV-neutral, acarbose has no CV indication, and sulfonylureas like glimepiride increase hypoglycemia risk without CV 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.