CASE STUDY
Patient V is a Hispanic man, 61 years of age, presenting to the primary care nurse practitioner with complaints of polydipsia, polyphagia, and fatigue for the past month. Upon further assessment, he states that he has recently had his eyeglass prescription adjusted due to blurred vision. He is 5 feet 10 inches tall and weighs 245 pounds; his calculated BMI is 35.2 kg/m2. The patient reveals a family history of diabetes. He works a physical job in a warehouse lifting 50-pound boxes. He occasionally golfs. A random finger stick reveals a blood glucose level of 220 mg/dL.
Patient V’s fasting blood work reveals the following:
• HbA1c: 8.7% (estimated average glucose: 203 mg/dL)
• Fasting blood glucose: 151 mg/dL
• Two-hour glucose level (after 75 g oral glucose tolerance test): 233 mg/dL
• Total: 250
• Triglycerides: 210 mg/dL
• LDL: 112 mg/dL
• HDL: 35 mg/dL
• Liver function tests: Within normal limits
• Renal function: Within normal limits
1. What are your initial steps for treatment for this patient? Please also discuss your rationale
When the patient returns to his primary care nurse practitioner in 3 months, his follow-up HbA1c demonstrates minimal change with the result of 8.2% (estimated average glucose: 189 mg/dL) and a fasting blood glucose level of 156 mg/dL. SMBG records reveal fasting blood glucose levels consistently between 135 mg/dL and 160 mg/dL and postprandial levels steadily between 220 mg/dL and 248 mg/dL. His lipid levels remain greater than goal as well. Patient V indicates that he has not been following his meal and exercise planning goals and has only experienced minimal success.
2. After evaluation of the patient’s blood work, history, and progress to date, what will be your next medication choice/choices? Please discuss your rationale for this
3. After 6 months of treatment with your medication of choice, FBS remains > 120 and Hg AIc is around 7. What would your next steps be and why?
Your patient returns one year after initial diagnosis. His HbA1c is 11.2 and he admits to not taking his medications every day over the last three months.
4. After discussing consequences of uncontrolled diabetes and importance of adhering to diet and exercise, what medication regimen would you prescribe for this patient? Please discuss your rationale.
5. Using the following article, briefly discuss pharmacological treatment recommendations for diabetic patients with hyptertension and hyperlipidemia. Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers | Clinical Diabetes | American Diabetes Association (diabetesjournals.org)
Standards of Medical Care in Diabetes—2022 Abridged for Primary Care Providers | Clinical Diabetes | American Diabetes Association
The American Diabetes Association’s (ADA’s) Standards of Medical Care in Diabetes (the Standards) is updated and published annually in a supplement to the January issue of Diabetes Care.The Standards are developed by the ADA’s multidisciplinary Professional Practice Committee, which comprises expert diabetes health care professionals.
diabetesjournals.org
