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Type 2 diabetes with established ASCVD — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Type 2 diabetes with established ASCVDUSMLE Step 3

A patient with type 2 diabetes and prior myocardial infarction has A1c 7.8% on metformin, eGFR 72 mL/min/1.73 m2 and no history of pancreatitis. They want weight loss and further cardiovascular risk reduction. What is the best add-on therapy?

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Correct answer: D — Add a GLP-1 receptor agonist with proven cardiovascular benefit

The best answer is “Add a GLP-1 receptor agonist with proven cardiovascular benefit”. In type 2 diabetes with established atherosclerotic cardiovascular disease, a GLP-1 receptor agonist can reduce cardiovascular risk and promote weight loss. Deferring treatment, adding glyburide, or switching directly to basal insulin misses those goals. Pioglitazone can cause fluid retention and does not deliver the preferred risk reduction in this setting.

Reference: American Diabetes Association, Standards of Care in Diabetes: https://diabetesjournals.org/care/issue/49/Supplement_1