A 65-year-old woman with type 2 diabetes and chronic kidney disease (eGFR 22 mL/min/1.73 m2) has fasting glucose well controlled on basal insulin but marked postprandial spikes. Which oral agent can be safely added without dose adjustment in advanced renal failure?
- A Repaglinide ✓
- B Glibenclamide
- C Metformin
- D Canagliflozin
Correct answer: A. Repaglinide
Explanation
Repaglinide is a meglitinide taken before each meal; it is metabolized hepatically to inactive metabolites with negligible renal excretion, so it needs no dose reduction even in dialysis patients and carries low hypoglycemia risk due to its short half-life. Glibenclamide has active renal-excreted metabolites causing prolonged hypoglycemia in CKD, metformin is contraindicated at this eGFR, and SGLT2 inhibitors lose efficacy below eGFR 30.
Reference: Katzung Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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