A man with type 2 diabetes and established heart failure is on metformin alone. His HbA1c is 52 mmol/mol. Which additional drug class is recommended by NICE?
Answer and explanation
Correct answer: C. An SGLT2 inhibitor such as dapagliflozin
- Step 1: Heart failure changes the drug choice.
- Step 2: NICE NG28 recommends adding an SGLT2 inhibitor for type 2 diabetes with chronic heart failure or established cardiovascular disease.
Answer
An SGLT2 inhibitor such as dapagliflozin.
Why not the others: A DPP-4 inhibitor such as saxagliptin: Saxagliptin is associated with heart failure hospitalisation. A sulfonylurea such as gliclazide: Sulfonylureas do not reduce heart failure events. Pioglitazone: Pioglitazone can worsen fluid retention and is contraindicated in heart failure.
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