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Type 2 diabetes with atherosclerotic cardiovascular disease — SCE Endocrinology MCQ

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HardDiabetesType 2 diabetes with atherosclerotic cardiovascular diseaseSCE Endocrinology

A 48-year-old man is reviewed after an HbA1c of 79 mmol/mol. He had an NSTEMI 9 months ago, BMI is 31 kg/m² and eGFR is 76 ml/min/1.73 m². He has no osmotic symptoms and takes atorvastatin, ramipril and aspirin. He is reluctant to start insulin at this stage. What is the most appropriate management?

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Correct answer: E — Start modified-release metformin, an SGLT2 inhibitor and weekly semaglutide

NICE NG28 now prioritises cardiorenal risk as well as glycaemia; established atherosclerotic cardiovascular disease supports initial metformin, an SGLT2 inhibitor and subcutaneous semaglutide if not contraindicated. Gliclazide or DPP-4 inhibitor therapy would be less aligned with the cardiovascular-risk phenotype. The teaching point is that modern type 2 diabetes prescribing starts with comorbidity phenotype, not HbA1c alone.

Reference: NICE NG28