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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: What are your initial treatment goals for KM? A: Reasonable initial targets for KM would be glycemic control, lipids, and blood pressure. It may be overwhelming for some patients to address all these issues at one time, but I frequently send a newly diagnosed patient home with several medications—metformin or a thiazolidinedione, an ACE inhibitor, and a statin. Aggressively treating all the components of insulin resistance may prevent cardiovascular complications,8 so you should address all the factors that you and the patient can handle as promptly as you can (see Table 5). I select the more aggressive AACE target of A1c<6.5%.4 As documented in DCCT,9 UKPDS,10 and other large epidemiologic studies,11 there is no threshold for complications, and aiming for near-normal glycemia in an otherwise healthy, relatively young patient is reasonable.
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