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SGLT2i in T1DM CKD — RACP Adult Medicine MCQ

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ModerateNephrologySGLT2i in T1DM CKDRACP Adult Medicine

A 40-year-old man with type 1 diabetes develops progressive renal impairment. His urine ACR is 120 mg/mmol and eGFR is 45 mL/min/1.73 m². He is on maximum dose ramipril. According to the latest KDIGO guidelines, should an SGLT2 inhibitor be commenced?

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Correct answer: C — SGLT2 inhibitors are contraindicated in type 1 diabetes

The EMPA-KIDNEY trial included patients with CKD regardless of diabetes status and demonstrated renal benefit. DAPA-CKD had similar findings. KDIGO 2024 now recommends SGLT2 inhibitors for CKD (eGFR ≥20) regardless of diabetes type. For type 1 diabetes, the risk of euglycaemic DKA exists but can be managed with patient education and close monitoring. The TGA listing and PBS criteria in Australia are evolving to include CKD indications beyond T2DM. Dapagliflozin is now TGA-approved for CKD regardless of diabetes status.

Reference: KDIGO – 2024 – CKD Guidelines; DAPA-CKD Trial; EMPA-KIDNEY Trial