Which of the following statements regarding agents used to treat Type 2 diabetes mellitus is FALSE?A. Metformin is contraindicated in patients with an eGFR of less than 60 mL/min/1.73 m2
Correct Answer: A
Metformin is the first drug recommended when starting treatment for type 2 diabetes. It reduces hemoglobin A1c by 1% to 1.5% and is associated with decreases in both the microvascular and macrovascular complications of diabetes. Recommendations against the use of metformin in patients with mild to moderate chronic kidney disease were removed by the FDA, as recent studies did not show an increased risk of lactic acidosis in these patients. However, metformin is contraindicated in patients with an eGFR <30 mL/min/1.73 m2.
Sulfonylureas also decrease hemoglobin A1c by 1% to 1.5% and have been shown to reduce long-term macrovascular and microvascular events. Adverse effects include weight gain and hypoglycemia.
GLP-1 receptor agonists also lower hemoglobin A1c by 1% to 1.5% and are associated with weight loss. They are associated with a reduced risk of cardiovascular mortality. Adverse effects include nausea, vomiting, diarrhea, acute renal failure due to volume depletion from vomiting and diarrhea, and acute pancreatitis.
DPP-4 inhibitors produce a small reduction in hemoglobin A1c (0.5%-1%). It has been associated with acute pancreatitis as well as hypersensitivity reactions.
SGLT2 inhibitors also produce a small reduction in hemoglobin A1c (0.5%-1%) and are also associated with a small decrease in systolic blood pressure and weight loss. Because SGLT2 inhibitors also increase sodium excretion, acute renal injury due to hypovolemia can occur.