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Type 2 diabetes with advanced CKD — SCE Endocrinology MCQ

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HardDiabetesType 2 diabetes with advanced CKDSCE Endocrinology

A 66-year-old man with type 2 diabetes has HbA1c 70 mmol/mol. He is taking gliclazide and ramipril. eGFR is 18 ml/min/1.73 m2 and he has poor appetite with recurrent hypoglycaemia. What is the most appropriate diabetes medication review?

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Correct answer: C — Stop gliclazide and consider a DPP-4 inhibitor with renal-appropriate dosing

Advanced CKD increases sulfonylurea hypoglycaemia risk; a DPP-4 inhibitor with renal adjustment is safer for glycaemia. Metformin is contraindicated at this eGFR. SGLT2 inhibitors may have renal indications at thresholds depending on drug and context, but glycaemic efficacy is low and this patient has recurrent hypoglycaemia requiring de-intensification.

Reference: NICE NG28; NICE NG203; BNF