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Type 2 diabetes and cardiovascular disease — CCFP MCQ

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HardChronic disease managementType 2 diabetes and cardiovascular diseaseCCFP

A 62-year-old with type 2 diabetes takes metformin. Six weeks ago he had an NSTEMI and now has stable coronary artery disease; A1C is 7.7%, eGFR 68 mL/min/1.73 m² and he has no symptomatic heart failure. Which medication-selection principle should guide the next glucose-lowering choice?

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Correct answer: A — Choose an agent with demonstrated cardiovascular outcome benefit

The best answer is “Choose an agent with demonstrated cardiovascular outcome benefit”. In type 2 diabetes with established coronary disease, select an SGLT2 inhibitor or GLP-1 receptor agonist with demonstrated cardiovascular benefit, regardless of baseline A1C, alongside metformin if tolerated. Drug cost and patient preferences matter, but choosing a sulfonylurea, basal insulin, or pioglitazone solely for glycemia does not prioritize cardiovascular outcome benefit.

Reference: Diabetes Canada: Pharmacologic glycemic management of type 2 diabetes—2024 update: https://guidelines.diabetes.ca/cpg/chapter-13-2024-update