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Type 2 Diabetes in Elderly — RACP Adult Medicine MCQ

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ModerateEndocrinologyType 2 Diabetes in ElderlyRACP Adult Medicine

A 75-year-old man with T2DM (HbA1c 62 mmol/mol) is on metformin 1 g daily. He has frequent hypoglycaemic episodes causing falls. His eGFR is 35 mL/min/1.73m². He lives alone. Which agent carries the lowest hypoglycaemia risk as add-on therapy?

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Correct answer: E — DPP-4 inhibitor (sitagliptin)

DPP-4 inhibitors have the lowest hypoglycaemia risk among glucose-lowering agents (comparable to placebo) and are well-tolerated in the elderly. They require dose adjustment in CKD (linagliptin is the exception). In an elderly patient with falls from hypoglycaemia who lives alone, minimising hypo risk is paramount.

Reference: Australian Diabetes Society – 2024 – T2DM Treatment Algorithm