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Metformin in CKD — UKMLA MCQ

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HardEndocrinologyMetformin in CKDUKMLAMRCP Part 1MRCGP AKTPARA

A frail 84-year-old with type 2 diabetes takes metformin and gliclazide. HbA1c is 44 mmol/mol and there have been three severe hypoglycaemic episodes in 2 months. Renal function is stable. What is the best medication review outcome?

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Correct answer: B — Withdraw gliclazide and relax the glycaemic target

The best answer is “Withdraw gliclazide and relax the glycaemic target”. For a frail older person with recurrent severe hypoglycaemia, a low HbA1c reflects excessive treatment rather than success. The sulfonylurea is the major hypoglycaemia driver and should be withdrawn or de-intensified while a safer individual target is agreed. Adding insulin or another agent increases treatment burden, and a generic low target must not override immediate harm.

Reference: NICE NG28, Type 2 diabetes in adults: recommendations: https://www.nice.org.uk/guidance/ng28/chapter/Recommendations