Endocrinology · NEET PG Preparation Medicine
A 60-year-old obese man with type 2 diabetes mellitus presents for routine checkup. His HbA1c is 8.2% despite maximal doses of metformin. He has a hi…
Practice question from Endocrinology (NEET PG Preparation Medicine), with the correct answer and a step-by-step solution.
easy · MCQ · Q-60B442
A 60-year-old obese man with type 2 diabetes mellitus presents for routine checkup. His HbA1c is 8.2% despite maximal doses of metformin. He has a history of congestive heart failure (NYHA Class III) and stage 3 chronic kidney disease. Which of the following classes of glucose-lowering agents should be added with demonstrated benefit for both heart failure and renal protection?
- A.Sulfonylureas
- B.Thiazolidinediones
- C.Sodium-glucose cotransporter-2 (SGLT2) inhibitorsCorrect answer
- D.Dipeptidyl peptidase-4 (DPP-4) inhibitors
Solution
SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) lower blood glucose by inhibiting glucose reabsorption in the proximal renal tubule. They have robust, proven cardiovascular benefits (reducing heart failure hospitalizations) and renal protective benefits (slowing the progression of chronic kidney disease), making them preferred agents in patients with type 2 diabetes and these comorbidities. Thiazolidinediones worsen heart failure. Sulfonylureas carry a high risk of hypoglycemia.
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