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Diabetes medication intensification — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Diabetes medication intensificationUSMLE Step 3

A 59-year-old woman with type 2 diabetes returns after 3 months of metformin and lifestyle changes. A1c decreased from 9.1% to 8.2%. She has established coronary artery disease and estimated GFR is 58 mL/min/1.73 m2. BMI is 33 kg/m2. Which of the following would you recommend at the follow-up visit?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Add a GLP-1 receptor agonist or SGLT2 inhibitor with cardiovascular benefit

Type 2 diabetes with ASCVD should include agents with cardiovascular benefit, individualized to kidney function, weight, and patient factors.

Reference: American Diabetes Association Standards of Care in Diabetes—2026: https://professional.diabetes.org/standards-of-care