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Type 2 diabetes with chronic kidney disease — RACP Adult Medicine MCQ

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ModerateEndocrinology and diabetesType 2 diabetes with chronic kidney diseaseRACP Adult Medicine

A 61-year-old man with type 2 diabetes takes metformin. HbA1c is 64 mmol/mol, eGFR is 52 mL/min/1.73 m2 and urine albumin-creatinine ratio is 42 mg/mmol. He has a prior myocardial infarction. What is the most appropriate management?

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Reveal the answer and explanation

Correct answer: B — Add an SGLT2 inhibitor if not contraindicated and optimise cardiovascular risk treatment

In type 2 diabetes with CKD and cardiovascular disease, SGLT2 inhibitors provide renal and cardiovascular benefit beyond glycaemic lowering when eGFR permits. Sulfonylureas may lower glucose but do not provide the same organ protection. Stopping kidney-protective therapy, using insulin for renal protection, or delaying treatment is suboptimal.

Reference: Australian Diabetes Society Glycaemic Management Algorithm; RACGP diabetes guidance; AMH