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Type 2 diabetes with heart failure — SCE Endocrinology MCQ

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ModerateDiabetesType 2 diabetes with heart failureSCE Endocrinology

A 47-year-old man with type 2 diabetes has HbA1c 69 mmol/mol and BMI 28 kg/m2. He has heart failure with preserved ejection fraction, eGFR 80 ml/min/1.73 m2 and recurrent symptomatic hypoglycaemia on gliclazide. What is the most appropriate medication change?

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Correct answer: E — Stop gliclazide and introduce an SGLT2 inhibitor

SGLT2 inhibitors are favoured in people with diabetes and heart failure phenotypes, while sulfonylurea hypoglycaemia should prompt reduction or discontinuation. Pioglitazone can worsen fluid retention. Prandial insulin would increase hypoglycaemia risk without addressing the heart failure priority.

Reference: NICE NG28; NICE NG106; BNF