A 58-year-old man with type 2 diabetes has eGFR 38 mL/min/1.73m² and HbA1c 8.4%. His current regimen includes metformin and sitagliptin. Which antidiabetic agent should be added for its demonstrated cardiovascular and renoprotective benefit in this setting?
- A Canagliflozin ✓
- B Glibenclamide
- C Pioglitazone
- D Insulin glargine
Correct answer: A. Canagliflozin
Explanation
SGLT2 inhibitors such as canagliflozin (CREDENCE trial) and dapagliflozin (DAPA-CKD trial) have proven cardiorenal benefits and are recommended down to eGFR 20–25 mL/min/1.73m² for their renoprotective effect, though glycaemic efficacy diminishes below eGFR 45. Glibenclamide risks hypoglycaemia and active metabolite accumulation in CKD. Pioglitazone causes fluid retention and is relatively contraindicated with low eGFR. Insulin is effective but lacks the specific renoprotective outcome data.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.