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Type 2 diabetes — SCE Endocrinology MCQ

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ModerateDiabetesType 2 diabetesSCE Endocrinology

A 58-year-old man with type 2 diabetes has HbA1c 73 mmol/mol despite lifestyle change. BMI is 33 kg/m2, eGFR 84 ml/min/1.73 m2 and urine ACR is 1.8 mg/mmol. He has no cardiovascular disease and takes amlodipine for hypertension. What is the most appropriate initial glucose-lowering treatment?

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Correct answer: B — Modified-release metformin and an SGLT2 inhibitor

NICE NG28 now places early emphasis on cardiorenal and weight-related benefit, so metformin with an SGLT2 inhibitor is the best initial option here. Insulin or sulfonylurea treatment would lower glucose but gives less cardiorenal benefit and more hypoglycaemia or weight gain. Pioglitazone is useful in selected patients but is not the preferred first step in this profile.

Reference: NICE NG28; BNF