A 52-year-old man with type 2 diabetes on metformin and sitagliptin develops bilateral lower limb oedema and dyspnoea. HbA1c is 8.2%. His cardiologist finds preserved ejection fraction heart failure (HFpEF). Which antidiabetic agent, if added, would provide the strongest evidence-based benefit for both glycaemic control and reduction of heart failure hospitalisation in this patient?
- A Liraglutide
- B Pioglitazone
- C Empagliflozin ✓
- D Insulin glargine
Correct answer: C. Empagliflozin
Explanation
SGLT2 inhibitors (empagliflozin, dapagliflozin) are the only antidiabetic agents with proven benefit in HFpEF, reducing hospitalisations in the EMPEROR-Preserved and DELIVER trials. GLP-1 agonists like liraglutide are neutral or possibly harmful in advanced heart failure. Pioglitazone causes fluid retention and worsens heart failure. Insulin glargine has no specific heart failure benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.