College

**Case CC:**

- **Patient Statement:** "I am here to find out the results of my blood tests."
- **History of Present Illness (HPI):** A 63-year-old Caucasian female presents to the family practice clinic on October 1, 2021, for a follow-up on her blood results.

**Past Medical History (PMH):**
- Hypertension (HTN)
- Type 2 Diabetes Mellitus (DM)
- Stroke

**Family History (FH):**
- Both parents have DM, HTN, and hyperlipidemia (both are alive).

**Social History (SH):**
- Alcohol: None
- No smoking history
- Physical Activity: Walks 150 minutes per week with resistance exercises twice a week
- Diet: Eats fried foods a couple of times a month

**Allergies:**
- No known drug allergies (NKDA)

**Medications:**
- Metformin 1000 mg twice a day
- ASA 81 mg once a day
- Hydrochlorothiazide 25 mg once a day

**Physical Examination (PE):**
- Blood Pressure: 148/94
- Height: 5’3’’
- Weight: 150 lbs

**Surgical History:** None

**Laboratory Values:**
- Fasting Blood Glucose: 150 mg/dL
- HDL: 43 mg/dL
- LDL: 150 mg/dL
- Triglycerides (TG): 200 mg/dL
- Total Cholesterol: 243 mg/dL
- ALT: 16
- AST: 18
- Urine Albumin Excretion: 35 mcg/mg creatinine (same result for 2 out of 3 in a 3-6 month period)
- Na: 140
- K: 4.0
- Mg: 2.0
- Ca: 9.5
- Albumin: 4.0
- Scr: 1.1 (normal range for female)
- BUN: 12
- HCO3: 20
- HbA1c: 7.9%
- TSH: Within Normal Limits (WNL)
- GFR: 65 ml/min/1.73m²

**Examinations:**
- Last eye exam: 5 years ago
- Last foot exam: 5 years ago

**Vaccinations:**
- Childhood vaccines (received Hepatitis B vaccine)
- Tdap and PCV-13 last year

**Additional Information:**
- The patient does not want an injectable medication.
- The patient does not want to start insulin at this time unless there are no other options available.
- The physician does not want to increase the metformin dose.
- The patient is compliant with taking medication daily.

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**Questions:**

1. What are the American Association of Clinical Endocrinology (AACE) HbA1c, fasting, and 2-hour postprandial blood glucose goals?

2. What is the most appropriate recommendation for this patient, and why was the therapy chosen (also include what should be done with the metformin)?

3. Does this person need any additional vaccines? If yes, what vaccines should they receive?

4. Does the patient need a foot exam? If yes, explain why.

5. Does the patient need an eye exam? If yes, explain why.

6. When should their next HbA1c be obtained, and explain why?

7. List 2 safety and 2 efficacy parameters of the medication that was chosen for the patient’s #1 health care need.

8. List at least 3 adverse effects of metformin.

9. List the microvascular complications of diabetes.

10. List the macrovascular complications of diabetes.

Answer :

Final answer:

For this diabetic patient, the addition of a dipeptidyl peptidase-4 inhibitor is recommended, with an annual zoster vaccine, and yearly foot, and eye exams. Next HbA1c test should be obtained in 3 months. Metformin can lead to potential adverse effects and diabetes can result in microvascular and macrovascular complications.

Explanation:

The American Association of Clinical Endocrinology (AACE) has set the HbA1c goal below 6.5%, fasting blood glucose goal of less than 110mg/dl and postprandial glucose level goal below 140mg/dl. For this patient, an addition of a dipeptidyl peptidase-4 inhibitor may be considered due to elevated HbA1c and blood glucose levels. The therapy was chosen as it works in complement with metformin, which the patient is already taking. In terms of vaccines, the patient should receive a zoster vaccine, and as the patient has diabetes, annual foot and eye exams are recommended to prevent microvascular complications of diabetes, such as neuropathy and retinopathy. The next HbA1c test should be obtained in 3 months to monitor the glycemic control. Metformin can lead to adverse effects such as gastrointestinal upset, lactic acidosis, and vitamin B12 deficiency. Microvascular complications of diabetes include neuropathy, nephropathy, retinopathy while macrovascular complications include cardiovascular diseases.

Learn more about Diabetes Management here:

https://brainly.com/question/32266743

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