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Type 2 diabetes with heart failure and CKD — SCE Endocrinology MCQ

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HardDiabetes mellitusType 2 diabetes with heart failure and CKDSCE Endocrinology

A 46-year-old woman with type 2 diabetes, heart failure with reduced ejection fraction and eGFR 52 ml/min/1.73 m2 has HbA1c 70 mmol/mol on metformin. She previously had genital candidiasis but no ketoacidosis. Blood pressure is 116/70 mmHg and urine ACR is 22 mg/mmol. What is the most appropriate management?

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Correct answer: E — Add an SGLT2 inhibitor after counselling on genital infection and sick-day precautions

Add an SGLT2 inhibitor after counselling on genital infection and sick-day precautions is best because heart failure and albuminuric CKD are strong indications for SGLT2 inhibitor therapy when renal function permits and risks are discussed. The alternatives are less appropriate because eGFR 52 does not preclude suitable agents; pioglitazone may worsen heart failure; gliclazide lacks the outcome benefit; basal insulin is not the preferred cardiorenal step. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28