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T2DM with Early CKD — RACP Adult Medicine MCQ

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ModerateEndocrinology & DiabetesT2DM with Early CKDRACP Adult Medicine

A 52-year-old man with type 2 diabetes, BMI 34, and hypertension is on metformin 2 g daily and perindopril 10 mg daily. His HbA1c is 62 mmol/mol and he has stage 2 CKD (eGFR 75 mL/min/1.73 m²) with microalbuminuria (ACR 5 mg/mmol). He has no CVD. What additional glucose-lowering agent provides the best cardiorenal benefit?

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Correct answer: D — Dapagliflozin

For patients with T2DM and CKD (even early stage with microalbuminuria), SGLT2 inhibitors (dapagliflozin or empagliflozin) are recommended regardless of HbA1c as they provide cardiorenal benefits independent of glycaemic control (DAPA-CKD, EMPA-KIDNEY trials). The KDIGO 2024 guidelines position SGLT2 inhibitors alongside metformin as foundational therapy for T2DM with CKD. Benefits include reduced CKD progression, reduced HF hospitalisation, and cardiovascular protection.

Reference: ADS – 2024 – Type 2 Diabetes Treatment Algorithm; KDIGO – 2024 – CKD Guidelines