A 52-year-old man with type 2 diabetes has eGFR 42 mL/min/1.73m² and HbA1c 9.2%. He is on metformin 1g BD. Which pharmacological intervention is MOST appropriate to add, given both glycaemic and cardio-renal benefit evidence?

• A Empagliflozin 10 mg once daily ✓
• B Sitagliptin 50 mg once daily
• C Pioglitazone 30 mg once daily
• D Glimepiride 2 mg once daily

Explanation

SGLT-2 inhibitors like empagliflozin have demonstrated cardiovascular and renal outcome benefits in the EMPA-REG OUTCOME and EMPA-KIDNEY trials. Empagliflozin is approved down to eGFR 20 mL/min for renal protection (with dose reduction at lower eGFR ranges). Sitagliptin provides glycaemic benefit but lacks proven cardio-renal protection at this magnitude. Pioglitazone has fluid retention concerns; glimepiride risks hypoglycaemia with no CV protection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.