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Diabetes ASCVD risk — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Diabetes ASCVD riskUSMLE Step 3

A 63-year-old man with type 2 diabetes and prior myocardial infarction has A1c 7.8% on metformin. eGFR is 72 mL/min/1.73 m2. BMI is 31 kg/m2. He has no heart failure. He asks whether another diabetes medication can reduce cardiovascular risk. Which of the following is the most appropriate next step in management?

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Correct answer: A — Add a GLP-1 receptor agonist with cardiovascular benefit

In type 2 diabetes with established ASCVD, GLP-1 receptor agonists with proven cardiovascular benefit or SGLT2 inhibitors are preferred independent of baseline A1c when appropriate.

Reference: ADA Standards of Care in Diabetes—2026