A 58-year-old man with type 2 diabetes on metformin and sitagliptin presents with HbA1c 8.9%, eGFR 52 mL/min/1.73m², BMI 34 kg/m², and established atherosclerotic cardiovascular disease. Which add-on agent has the strongest evidence for reducing major adverse cardiovascular events in this patient?
- A Alogliptin
- B Glimepiride
- C Pioglitazone
- D Empagliflozin ✓
Explanation
The EMPA-REG OUTCOME trial demonstrated that empagliflozin significantly reduced major adverse cardiovascular events (MACE), cardiovascular death, and hospitalisation for heart failure in patients with T2DM and established ASCVD. SGLT2 inhibitors and GLP-1 receptor agonists with proven cardiovascular benefit are now recommended as preferred add-ons in this setting per ADA 2024 and Harrison's guidelines. Alogliptin (DPP-4i) showed non-inferiority but not superiority in EXAMINE. Glimepiride carries hypoglycaemia risk without CV benefit. Pioglitazone has modest CV data but causes fluid retention, worsening heart failure risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.