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Type 2 diabetes with heart failure — SCE Endocrinology MCQ

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HardDiabetesType 2 diabetes with heart failureSCE Endocrinology

A 62-year-old woman with newly diagnosed type 2 diabetes has an HbA1c of 72 mmol/mol. She has heart failure with reduced ejection fraction and eGFR 58 ml/min/1.73 m². She had severe diarrhoea with standard-release metformin after a previous trial for prediabetes. Examination shows no dehydration or ketonuria. What is the most appropriate management?

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Correct answer: D — Offer modified-release metformin and an SGLT2 inhibitor

Heart failure is a strong indication for an SGLT2 inhibitor, and modified-release metformin can be used when standard-release metformin is not tolerated. Pioglitazone is unsuitable in heart failure because of fluid retention risk. The pearl is that metformin intolerance does not necessarily exclude a modified-release formulation.

Reference: NICE NG28, BNF