A patient with type 2 diabetes on glimepiride has recurrent episodes of hypoglycemia requiring dose reduction, but HbA1c rises to 8.5% after stopping it. Which antidiabetic agent is most appropriate as a replacement that carries the lowest risk of hypoglycemia?
- A Sitagliptin ✓
- B Gliclazide MR
- C Repaglinide
- D Pioglitazone
Correct answer: A. Sitagliptin
Explanation
DPP-4 inhibitors like sitagliptin carry minimal hypoglycemia risk because their insulinotropic effect is glucose-dependent. Repaglinide (C) and gliclazide (B) are insulin secretagogues with hypoglycemia risk. Pioglitazone (D) carries minimal hypoglycemia risk but is less preferred here due to its side effect profile including weight gain, edema, and fracture risk, making sitagliptin the better choice.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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