Type 2 Diabetes Mellitus — SCE Endocrinology MCQ

Correct answer: E — Semaglutide

Semaglutide (E) is correct because as a once weekly subcutaneous GLP-1 receptor agonist it produces substantial glycaemic lowering alongside clinically meaningful weight loss, matching this patient's explicit preference for weight reduction and weekly dosing on top of metformin with A1c 8.5% and BMI 39. GLP-1 receptor agonists such as semaglutide are recommended in NICE NG28 for people with type 2 diabetes and a high BMI who need additional glucose lowering and would benefit from weight loss, reflecting their dual incretin-mediated effect of enhancing glucose dependent insulin secretion and suppressing appetite via central satiety pathways. Unlike sulfonylureas or insulin, semaglutide carries a low hypoglycaemia risk when used without insulin secretagogues and its cardiometabolic weight benefit aligns with guideline priorities for obesity plus T2D. Why the other options are wrong: B. Glipizide: a sulfonylurea that stimulates insulin secretion regardless of glucose level, causing weight gain and hypoglycaemia risk, the opposite of this patient's goals. C. Sitagliptin: a DPP-4 inhibitor is weight neutral and given once daily, offering only modest A1c reduction, so it fails both the weight loss and dosing-frequency requirements. D. Basal insulin: effective for glycaemic control but typically causes weight gain and requires daily injections, undesirable when an oral/weekly weight-losing option exists at this A1c level. E.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/diabetes-and-other-endocrinal-nutritional-and-metabolic-conditions