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Type 2 diabetes with chronic kidney disease — SCE Endocrinology MCQ

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ModerateDiabetes mellitusType 2 diabetes with chronic kidney diseaseSCE Endocrinology

A 69-year-old man with type 2 diabetes and CKD stage 3b has HbA1c 72 mmol/mol. eGFR is 24 ml/min/1.73 m2 and albumin:creatinine ratio is 48 mg/mmol. He stopped metformin because of gastrointestinal adverse effects and has no history of ketoacidosis. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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

Start dapagliflozin or empagliflozin with a DPP-4 inhibitor is best because NICE supports selected SGLT2 inhibitor use at this eGFR with additional glucose-lowering therapy when metformin is not tolerated. The alternatives are less appropriate because full-dose metformin is unsuitable at this eGFR; pioglitazone lacks the renal indication; insulin may be needed later but is not the preferred first move; semaglutide alone misses the renal strategy. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28