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Chronic hypercapnia in obesity — RCPSC IM MCQ

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HardRespirologyChronic hypercapnia in obesityRCPSC IM

A patient with type 2 diabetes and CKD has HbA1c 9.2% despite metformin and an SGLT2 inhibitor. They have obesity, established atherosclerotic cardiovascular disease and no history of pancreatitis. Which additional glucose-lowering class should be prioritized?

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

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

D is correct: a GLP-1 receptor agonist with cardiovascular benefit is appropriate for persistent hyperglycaemia with obesity and ASCVD. E causes weight gain. A can cause fluid retention. B removes cardiorenal benefit. C is not mandated solely by CKD.

Reference: Diabetes Canada, CKD in Diabetes: https://guidelines.diabetes.ca/cpg/chapter-29-2025-update