A 52-year-old man with type 2 diabetes on metformin 1g BD and sitagliptin 100 mg OD presents with HbA1c of 9.8%. He has eGFR 48 mL/min/1.73m² and established cardiovascular disease. According to current ADA/ESC guidelines, which agent should be preferentially added to his regimen?
- A Pioglitazone
- B Glipizide
- C Empagliflozin ✓
- D Exenatide
Correct answer: C. Empagliflozin
Explanation
Current ADA 2024 and ESC guidelines prioritise SGLT2 inhibitors (empagliflozin, dapagliflozin) in T2DM with established ASCVD because of proven cardiovascular and renal outcome benefits (EMPA-REG OUTCOME trial). Empagliflozin is safe with eGFR ≥20 for cardiorenal benefits, though glucose-lowering is blunted below 45. Pioglitazone risks fluid retention in CVD; glipizide offers no cardiorenal protection; exenatide (GLP-1 RA) would be second-line if SGLT2i is contraindicated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.