AOBIM Internal Medicine Practice Questions - AOBIM Internal Medicine Certifying Examination Exam

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A 60-year-old woman with newly diagnosed type 2 diabetes has eGFR 35 mL/min/1.73m2 and a UACR of 350 mg/g. Her A1c is 8.4%. She is currently only on metformin 500 mg BID. According to ADA 2026 standards, what is the best next step?

Discontinue metformin (eGFR <45 contraindication) Continue metformin (acceptable down to eGFR 30; do not initiate <45) and add an SGLT2 inhibitor for renal protection Add a sulfonylurea Add basal insulin only

Correct Answer:

Continue metformin (acceptable down to eGFR 30; do not initiate <45) and add an SGLT2 inhibitor for renal protection

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