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Type 2 Diabetes with CVD — RACP Adult Medicine MCQ

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ModerateEndocrinologyType 2 Diabetes with CVDRACP Adult Medicine

A 52-year-old man with type 2 diabetes (HbA1c 66 mmol/mol) is on metformin 2 g daily. He has an eGFR of 50 mL/min/1.73m² with ACR 15 mg/mmol. BMI is 32 kg/m². He has established cardiovascular disease. What is the most appropriate additional agent?

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Correct answer: A — SGLT2 inhibitor (empagliflozin)

SGLT2 inhibitors are the preferred add-on to metformin in patients with T2DM and established CVD, CKD, or albuminuria. The EMPA-REG OUTCOME trial showed cardiovascular mortality benefit. SGLT2 inhibitors also provide renoprotection. At eGFR 50, empagliflozin can be initiated and continued down to eGFR 20 for cardiorenal benefit.

Reference: Australian Diabetes Society – 2024 – T2DM Treatment Algorithm; KDIGO 2024