A 52-year-old man with type 2 diabetes on metformin 2 g/day has HbA1c of 8.4%. His eGFR is 38 mL/min/1.73 m². Which agent, if added, carries the STRONGEST evidence for both HbA1c reduction AND reduction in CKD progression at this eGFR?
- A Canagliflozin (kidney protection dose 100 mg) ✓
- B Empagliflozin
- C Sitagliptin
- D Glimepiride
Correct answer: A. Canagliflozin (kidney protection dose 100 mg)
Explanation
The CREDENCE trial established canagliflozin 100 mg (the kidney protection dose) as the first SGLT2 inhibitor to demonstrate significant reduction in the primary composite of end-stage kidney disease, doubling of serum creatinine, or renal/cardiovascular death in patients with type 2 diabetes and CKD (eGFR 30–90). Empagliflozin's EMPA-KIDNEY trial also showed benefit but canagliflozin's CREDENCE specifically enrolled CKD patients and is approved down to eGFR 30 for renoprotection. Sitagliptin and glimepiride lack evidence for CKD progression reduction.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.