A 54-year-old man with type 2 diabetes on metformin and sitagliptin has an HbA1c of 9.2%. He has an eGFR of 48 mL/min/1.73m², albuminuria of 180 mg/day, and established cardiovascular disease. According to the 2023 ADA Standards of Care, which add-on agent is MOST preferred in this patient?
- A Pioglitazone
- B Glimepiride
- C Empagliflozin ✓
- D Exenatide
Correct answer: C. Empagliflozin
Explanation
In patients with T2DM, established cardiovascular disease, and CKD with albuminuria, SGLT-2 inhibitors like empagliflozin provide proven cardiovascular mortality reduction (EMPA-REG OUTCOME) and nephroprotection independent of glycaemia. Empagliflozin is approved down to eGFR 20-30 for cardiovascular/renal benefit. Pioglitazone can cause fluid retention worsening heart failure; glimepiride increases hypoglycaemia risk; exenatide is effective but lacks the CKD-specific organ protection of SGLT-2 inhibitors.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.