A 66-year-old man with type 2 diabetes has HFrEF, albuminuric CKD and A1c 7.8% on metformin. eGFR is 42 mL/min/1.73 m2 and urine ACR is 22 mg/mmol.

Question

A 66-year-old man with type 2 diabetes has HFrEF, albuminuric CKD and A1c 7.8% on metformin. eGFR is 42 mL/min/1.73 m2 and urine ACR is 22 mg/mmol. He has no history of ketoacidosis or recurrent genital infection. Blood pressure is controlled. What is the most appropriate management?

Accepted Answer

Add an SGLT2 inhibitor with cardiorenal benefit

Answer

Use pioglitazone because he has heart failure

Answer

Stop metformin and use sliding-scale insulin alone

Answer

Add glyburide as preferred second-line therapy

Answer

Start DPP-4 inhibitor as preferred cardiorenal therapy

Type 2 diabetes with heart failure and CKD — RCPSC IM MCQ

A 66-year-old man with type 2 diabetes has HFrEF, albuminuric CKD and A1c 7.8% on metformin. eGFR is 42 mL/min/1.73 m2 and urine ACR is 22 mg/mmol. He has no history of ketoacidosis or recurrent genital infection. Blood pressure is controlled. What is the most appropriate management?