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VOLUME 1 ISSUE 1 CASE KM	KM is a 43-year-old woman, who was originally born in India but has lived in the US since she was 19 years old.
CHIEF COMPLAINT KM complains of heel pain, especially bad with first step in morning and gradually improving throughout the day. MEDICAL HISTORY Patient states she last saw a physician 3 years ago. You have no records of past visits at your practice. PHYSICAL EXAMINATION »  Height: 5 ft. 1 in. »  Weight: 185 lbs. »  Slight heel tenderness and discomfort stretching the foot. »  Blood pressure: 135/88 mm Hg (average of two measurements). »  Waist circumference: 39 in. FAMILY HISTORY »  Both parents living. »  Grandparents deceased from heart disease and cancer. »  Mother has type 2 diabetes. SOCIAL HISTORY »  KM does not exercise. »  Rare alcohol use. »  Never smoked. PROBLEMS »  Plantar fasciitis »  Obesity »  Other? TREATMENT »  Heel cushion »  Arch support »  Stretches NAVIGATION »  Q1: What else would you do at this visit? »  Q2: What is KM’s body mass index (BMI) and weight classification? »  Q3: Is KM a candidate for diabetes screening? »  Q4: What blood tests would you order? »  Q5: What do you do now? »  Q6: How would you confirm or rule out a diagnosis of diabetes? »  Q7: What is your diagnosis now? »  Q8: What is your initial treatment plan? »  Q9: What are your initial treatment goals for KM? »  Q10: What other interventions should you suggest at your next visit(s)? When should you see this patient again?	Q: How would you confirm or rule out a diagnosis of diabetes? A: It would be reasonable to either perform a 2-h glucose tolerance test or to ask the patient to stop in 2 hours after lunch to conduct a random glucose measurement and an A1c. The patient agrees to the latter course, and she registers a random glucose value of 235 g/dL and an A1c of 7.1%. Note: The A1c is not used here as a screening test, but more for ‘staging’ purposes. Once diabetes is confirmed, the A1c can assist in designing the patient’s management plan.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.tju.edu/jeffcme
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