QuestionSBA
QuestionChoice
As the patient has established cardiovascular disease, a SGLT-2 inhibitor is preferable. Pioglitazone has been linked to worsened outcomes in patients with heart disease and therefore should not be used in this circumstance.
10028362
b
Pioglitazone
QuestionChoice
As the patient has established cardiovascular disease, a SGLT-2 inhibitor is preferable. A DPP-4 inhibitor would have otherwise been an appropriate agent to commence for second-line treatment.
10028365
e
Sitagliptin
QuestionChoice
Given this patient has a history of ischaemic heart disease, they should be offered a SGLT-2 inhibitor in conjunction with metformin given the proven cardiovascular benefits of this class of medication.
10028361
a
Dapagliflozin
QuestionChoice
As the patient has established cardiovascular disease, a SGLT-2 inhibitor is preferable. A sulfonylurea would have otherwise been an appropriate agent to commence for second-line treatment.
10028363
c
Gliclazide
QuestionChoice
This may be considered if second line therapy (combination of two anti-diabetic medication) fails, however, it would not be routinely offered after just metformin was trialled.
10028364
d
Insulin
Concept
Chapter
2693
3761
Type 2 Diabetes Mellitus
Topic
133
Endocrinology
18070
In patients with diabetes and ischaemic heart disease, SGLT-2 inhibitors like dapagliflozin provide significant cardiovascular benefits alongside metformin.
A 67-year-old male has a routine HbA1c check as part of his diabetes management. He was started on metformin 12 months ago.

He has a past medical history of ischaemic heart disease.

* HbA1c: 67mmol/mol (patient target 48mmol/mol)

Given this result, which additional medication should he be offered in conjunction with metformin?
a