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T1DM Nephropathy — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModerateDiabetic Kidney DiseaseT1DM NephropathyESENeph

A 48-year-old woman with type 1 diabetes and CKD G3bA3 (eGFR 32 mL/min/1.73m2, uACR 55 mg/mmol) is on Lisinopril 20 mg and insulin. Her HbA1c is 62 mmol/mol. Which of the following is true regarding SGLT2 inhibitor use in this patient?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — SGLT2i should not be prescribed due to type 1 diabetes and increased risk of DKA

SGLT2 inhibitors are not recommended in type 1 diabetes due to the significantly increased risk of diabetic ketoacidosis (DKA). KDIGO 2024 specifically recommends SGLT2i for T2D and CKD (1A for eGFR ≥20 with T2D, and 1A for non-diabetic CKD with eGFR ≥20 and ACR ≥200 mg/g). However, the benefit-risk balance in type 1 diabetes is unfavourable due to DKA risk. No SGLT2i is approved for T1D in the UK.

Reference: KDIGO 2024 – CKD Guideline; BNF – Dapagliflozin SPC