Test Your Knowledge #531: A Caucasian Man with Newly Diagnosed Type 2 Diabetes and Renal Insufficiency, Part Three of Three

Despite his physician's recommendation at that time to go on medication to treat his diabetes, Mr. Johnson insisted he felt fine and wanted to try diet and exercise to see if he could avoid medication. He stated that his wife, who also has Type 2 diabetes, had the knowledge to help him with the changes.

In addition to his diabetes, Mr. Johnson has a 17-year history of hypertension and dyslipidemia, neither of which were well-controlled until 3 years ago

• Had a cardiac catheterization 3 years ago and was diagnosed with mild diffuse cardiovascular disease, but an intervention was not indicated at that time
• Has stable angina
• Was diagnosed with renal insufficiency 2 years ago

During the visit, Mr. Johnson, who works as a construction supervisor, explained that he has had an increase in the amount of stress in his life during the past 6 months and that he has not been very successful at watching his diet. This has been putting a strain on his marriage and he states he now realizes he needs to get control of his diabetes in order to improve both his health and his marriage.

The treatment options were discussed with Mr. Johnson and his wife, and it was decided that he would start sitagliptin 50 mg daily. Mr. Johnson stated he preferred to start treatment with a medication that was less likely to cause weight gain and had a low incidence of side effects.  

A prescription was also given for furosemide 40 mg daily to improve his hypertension and 1+ ankle edema. 

After a serious discussion with his physician, Mr. Johnson stated that he now understood how important good glycemic control is to improving his Type 2 diabetes, preventing further decline in his renal function, and decreasing his cardiovascular disease risk. He was told that lifestyle changes could be just as important as medication in improving his health, and he agreed to attend a series of diabetes self-management education (DSME) classes with his wife.

Follow-up 

Three months after his initial visit, Mr. Johnson and his wife returned for a follow-up visit. Mr. Johnson reported he was tolerating the medication well and that he had learned a great deal from the DSME classes taught by a nurse and a dietitian, both of whom were diabetes educators. Although the class format and group support was nice, he found he still had some questions about how much protein and salt he should eat due to his kidney disease and hypertension.  

He reported that even though he learned that sitagliptin is unlikely to cause hypoglycemia, he is now self-monitoring his blood sugars occasionally after meals, and this was helping him adjust his diet and portion sizes. However, he was still having difficulty finding time to exercise, but he was walking with his wife after dinner for 20-30 minutes several days a week.

His wife said she was much happier now that her husband was taking better care of himself and she reported that her A1c had also improved.

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