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Type 2 diabetes with established ASCVD — SCE Endocrinology MCQ

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EasyDiabetes mellitusType 2 diabetes with established ASCVDSCE Endocrinology

A 63-year-old man with type 2 diabetes attends review after myocardial infarction. He takes modified-release metformin 1 g twice daily. HbA1c is 64 mmol/mol, eGFR 78 ml/min/1.73 m2 and BMI 31 kg/m2. He has no urinary symptoms and blood pressure is controlled on ramipril. What is the most appropriate management?

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

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Correct answer: B — Add an SGLT2 inhibitor and subcutaneous semaglutide

Add an SGLT2 inhibitor and subcutaneous semaglutide is best because established atherosclerotic cardiovascular disease should shift treatment towards agents with cardiovascular and renal outcome benefit when suitable. The alternatives are less appropriate because gliclazide lowers glucose without the same outcome benefit; insulin is not the preferred next escalation; pioglitazone is less attractive after MI; a DPP-4 inhibitor would not offer comparable cardiorenal protection. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28