A 58-year-old man with type 2 diabetes mellitus and estimated GFR 38 mL/min/1.73m² is currently on metformin 1000 mg twice daily. His HbA1c is 8.6%. Which of the following glucose-lowering agents has the strongest evidence for reducing hospitalisation for heart failure in this patient, while also being safe at his current renal function?
- A Liraglutide
- B Empagliflozin ✓
- C Sitagliptin
- D Pioglitazone
Explanation
SGLT2 inhibitors, particularly empagliflozin (EMPA-REG OUTCOME trial) and dapagliflozin (DAPA-HF), are the only glucose-lowering agents with robust evidence for reducing hospitalisation for heart failure. Empagliflozin is approved down to eGFR 20–30 mL/min/1.73m² for cardiovascular/renal benefit even without significant glucose-lowering. Liraglutide reduces major adverse cardiovascular events (LEADER trial) but has no proven heart-failure benefit and may slightly worsen it. Sitagliptin was neutral (TECOS trial). Pioglitazone is contraindicated in heart failure due to fluid retention.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.