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Diabetic kidney disease — SCE Endocrinology MCQ

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ModerateDiabetesDiabetic kidney diseaseSCE Endocrinology

A 48-year-old woman with type 2 diabetes has eGFR 24 ml/min/1.73 m2 and HbA1c 78 mmol/mol. She stopped metformin because of gastrointestinal intolerance. She has no ketotic symptoms and is clinically stable. What is the most appropriate glucose-lowering strategy?

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Correct answer: D — Dapagliflozin or empagliflozin with a DPP-4 inhibitor

At eGFR 20–30 ml/min/1.73 m2, NICE NG28 supports dapagliflozin or empagliflozin with a DPP-4 inhibitor when metformin is not appropriate. Restarting metformin at this eGFR is unsafe. Insulin or pioglitazone may be considered later, but the question asks for the best next step.

Reference: NICE NG28; BNF