Type 2 Diabetes with CVD — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesType 2 Diabetes with CVDRACP Adult Medicine

A 58-year-old woman with a BMI of 42 presents with an HbA1c of 66 mmol/mol on metformin 2 g daily. She has a history of CVD (prior MI). According to current Australian guidelines, which additional agent provides the greatest cardiovascular benefit?

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Correct answer: C — Liraglutide (GLP-1 RA)

For patients with type 2 diabetes and established cardiovascular disease, GLP-1 receptor agonists (liraglutide – LEADER trial; semaglutide – SUSTAIN-6/SELECT trials) have demonstrated significant reductions in major adverse cardiovascular events (MACE). SGLT2 inhibitors also reduce MACE but their primary cardiovascular benefit is in heart failure and renal outcomes. In a patient with prior MI and obesity, a GLP-1 RA provides the most targeted cardiovascular benefit.

Reference: ADS – 2024 – Type 2 Diabetes Treatment Algorithm; eTG – 2025 – Endocrinology