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Clinical Case Vignette: Treatment Next Steps

May 19, 2018
 

Mrs. Hunter is a 36-year-old African-American who comes to your office for her annual wellness exam. She has excess weight (BMI 27 kg/m2), but is otherwise healthy. She jokes that she, “just can’t seem to lose that extra baby weight” after giving birth 3 years ago. However, her daughter recently started preschool so she has been able to go to her new gym several times per week. In fact, one of the added bonuses of her membership is that she has been participating in their free, weekly nutrition and exercise support groups. In addition to her routine labs, you order an A1C, which comes back elevated at 7.1%. This measurement is confirmed several days later.

Based on Mrs. Hunter’s profile, what would a reasonable next step be?

Correct

Answer: C. Encourage lifestyle modifications and do not initiate drug therapy at this time.

Educational Critique: Encourage lifestyle modifications and do not initiate drug therapy at this time. In general, for patients who are already near target (A1C<7%) at time of diagnosis and are highly motivated to engage in lifestyle modifications, it is reasonable to give a window of opportunity to engage in lifestyle modifications for a trial period of 3-6 months before embarking on pharmacotherapy. In select patients (highly motivated, newly diagnosed, long life expectancy, no significant comorbidities), more stringent A1C targets (<6.5%) may be considered as long as they can be achieved without adverse treatment effects or significant hypoglycemia.

Incorrect