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Course of Disease
At diagnosis, PD had two elevated fasting blood glucose results—154 mg/dL and 165 mg/dL, respectively. Her HbA1c was 8.8%. Other findings included normal blood pressure (124/72) and hypercholesterolemia with increased LDL-C (LDL 170 mg/dL, HDL 52 mg/dL, triglycerides 115 mg/dL). She was 5'10" and overweight, but not obese, with a weight of 195 lbs (BMI of 28 kg/m2) and a waist circumference of 36 inches. At that time, PD did not meet the criteria for the metabolic syndrome. Although this weight was her highest ever, it had not changed significantly in the 2 years prior to her diagnosis, and she was not currently losing weight. Her medical history revealed that she had gestational diabetes with her second child at age 30, and this condition was managed with diet. Review of her current exercise and diet showed that lifestyle change was unlikely to provide significant benefit. She was already consuming a calorie-controlled diet, and she participated in both aerobic and anaerobic exercise at a gym four times weekly.
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