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The Bottom Line: Achieving Diabetes Treatment Goals
VOLUME 1 ISSUE 2
CASE WM
WM is a 55-year-old man with new onset diabetes.
CHIEF COMPLAINT
WM complains of polydipsia, fatigue, and polyuria.
LABORATORY VALUES
» Fasting glucose: 256 mg/dL
» Fasting C-peptide: 8 ng/dL (normal: <5)
» A1c: 9.2 %
» Blood pressure: 145/90 mm Hg
» Lipid profile
 -- Total cholesterol: 233 mg/dL
 -- Triglycerides: 360 mg/dL
 -- High-density lipoprotein: 21 mg/dL
 -- Calculated low-density lipoprotein: 132 mg/dL
 -- Non-HDL cholesterol: 212 mg/dL
PROBLEMS
This patient displays several features typical of type 2 diabetes, including:

1. Uncontrolled hyperglycemia
2. Moderate hypertension
3. Dyslipidemia


Please Note: This issue of The Bottom Line has expired and CE credit is no longer available.

Continue

Q1: What is your first step?

Q2: What is your initial treatment plan to manage this patient’s hyperglycemia and dyslipidemia?

One-Month Follow-Up

Q3: How would you characterize WM’s cardiovascular risk based on this lipid profile?

Q4: How could you further characterize WM’s lipid profile?

Q5: What pharmacologic interventions can increase total HDL and HDL2?

Q6: What are the expected results if a TZD and statin are used in combination?

Q7: What other changes, if any, do you make in WM’s treatment plan?

Q8: What are the advantages and disadvantages of adding a fibrate or niacin?

Q9: You decide to add fenofibrate 54 mg/d to target triglycerides and HDL-C. What should you do if WM reports suggestive muscle symptoms?


Continue

Issue Date: June 2003
Expiration Date: June 2004
Questions? Contact 1-888-JEFF-CME (533-3263) or
http://jeffline.jefferson.edu/jeffcme


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