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Type 2 diabetes with ASCVD — SCE Endocrinology MCQ

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ModerateDiabetesType 2 diabetes with ASCVDSCE Endocrinology

A 62-year-old woman with type 2 diabetes and previous myocardial infarction has HbA1c 69 mmol/mol. eGFR is 72 ml/min/1.73 m2 and BMI is 31 kg/m2. She is not taking any glucose-lowering medicine and has no contraindications. What is the most appropriate management?

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Correct answer: A — Modified-release metformin, an SGLT2 inhibitor and subcutaneous semaglutide

In type 2 diabetes with established atherosclerotic cardiovascular disease, NICE NG28 supports early combination treatment with metformin, an SGLT2 inhibitor and subcutaneous semaglutide for cardiovascular, renal and glycaemic benefit. Metformin alone is too conservative for this risk phenotype. Sulfonylurea- or insulin-led strategies may be appropriate later but do not match the preferred cardiorenal approach.

Reference: NICE NG28; BNF