Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What medication would be most suitable for a newly diagnosed obese woman with type 2 diabetes and chronic kidney disease?

1. Canagliflozin

2. Metformin XR

3. Sitagliptin

4. Rosiglitazone

The correct answer is: Sitagliptin

In considering the most suitable medication for a newly diagnosed obese woman with type 2 diabetes and chronic kidney disease, Sitagliptin stands out as the appropriate choice. Sitagliptin, a DPP-4 inhibitor, is often well-tolerated, has a favorable safety profile, and is weight-neutral, which can be beneficial for an obese patient. Importantly, Sitagliptin can be used in patients with chronic kidney disease, though dose adjustments may be necessary depending on the severity of the renal impairment. While Canagliflozin is an SGLT2 inhibitor that promotes weight loss and has cardiovascular benefits, it is contraindicated in patients with significant renal impairment due to the risk of adverse effects. Metformin XR, while effective for weight loss and improving insulin sensitivity, is generally avoided in patients with significant renal dysfunction because it carries a risk of lactic acidosis. Rosiglitazone, a thiazolidinedione, may exacerbate fluid retention and is typically avoided in patients with heart failure or renal issues, making it less suitable for someone with chronic kidney disease. Therefore, Sitagliptin is the most appropriate choice, as it provides effective blood glucose control while being safe for patients with renal concerns.