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GLP-1 RA Pleiotropic Benefits CKD — ESENeph MCQ

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HardDiabetic Kidney DiseaseGLP-1 RA Pleiotropic Benefits CKDESENeph

A patient with type 2 diabetes and CKD remains above an individualised HbA1c target despite metformin and an SGLT2 inhibitor. BMI is 34 kg/m² and atherosclerotic cardiovascular disease is present. Which next glucose-lowering class is preferred?

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

Reveal the answer and explanation

Correct answer: D — Long-acting GLP-1 receptor agonist with cardiovascular-outcome evidence

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

C is correct. KDIGO recommends a long-acting GLP-1 receptor agonist when a person with type 2 diabetes and CKD has not met an individualised glycaemic target despite metformin and an SGLT2 inhibitor, or cannot use them. Cardiovascular benefit and weight reduction make it particularly suitable here. A combines overlapping incretin pathways without added benefit and is not recommended. B discards an organ-protective drug and increases hypoglycaemia risk. D ignores fluid retention. E mistakes the limitations of HbA1c in advanced CKD for abolition of glycaemic goals. Dose selection follows the licensed product and kidney function.

Reference: KDIGO 2022 guideline for diabetes management in CKD: https://kdigo.org/wp-content/uploads/2022/10/KDIGO-2022-Clinical-Practice-Guideline-for-Diabetes-Management-in-CKD.pdf