A 64-year-old man with type 2 diabetes returns for follow-up. A1c is 8.1% despite metformin. He has prior myocardial infarction and estimated GFR of

Question

A 64-year-old man with type 2 diabetes returns for follow-up. A1c is 8.1% despite metformin. He has prior myocardial infarction and estimated GFR of 72 mL/min/1.73 m2. BMI is 31 kg/m2. He has no history of pancreatitis. Which of the following is the most appropriate next step in management?

Accepted Answer

Add a GLP-1 receptor agonist with cardiovascular benefit

Answer

Stop metformin and start insulin alone

Answer

Start acarbose as cardiovascular risk therapy

Answer

Use pioglitazone despite heart disease

Answer

Add glyburide as preferred second-line therapy

Type 2 diabetes with ASCVD — USMLE Step 3 MCQ

A 64-year-old man with type 2 diabetes returns for follow-up. A1c is 8.1% despite metformin. He has prior myocardial infarction and estimated GFR of 72 mL/min/1.73 m2. BMI is 31 kg/m2. He has no history of pancreatitis. Which of the following is the most appropriate next step in management?