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Type 2 diabetes with chronic kidney disease — SCE Endocrinology MCQ

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HardDiabetesType 2 diabetes with chronic kidney diseaseSCE Endocrinology

A 55-year-old man with type 2 diabetes has HbA1c 69 mmol/mol and eGFR 24 ml/min/1.73 m². Urine ACR is 86 mg/mmol and he is taking maximum tolerated ACE inhibitor therapy. He has no history of ketoacidosis and is clinically euvolaemic. What is the most appropriate management?

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Correct answer: E — Start dapagliflozin or empagliflozin with a DPP-4 inhibitor

NICE NG28 gives a specific renal-function pathway for eGFR 20–30 ml/min/1.73 m², favouring dapagliflozin or empagliflozin plus a DPP-4 inhibitor. Metformin is generally avoided at this level of renal impairment. The key distinction is that low eGFR changes the glucose-lowering choices but does not automatically remove the renal-protective role of selected SGLT2 inhibitors.

Reference: NICE NG28, UK Kidney Association guidance