Test Your Knowledge Issue 429

He is a sales manager for a national manufacturing company and lives with his wife and one of his three children, a high school junior; his two older children are away at college. For the past 5 years, his body mass index has risen, and weight loss, exercise, and smoking cessation have been recommended to him many times. He attributes his weight and lifestyle to his stressful job that involves many restaurant meals and time spent away from home. His initial therapy was referral to a dietitian for a weight-loss diet and blood glucose self-monitoring twice daily. At this visit, he says that he cannot change his eating habits, that he is too busy with his job to exercise, and that he stopped blood glucose monitoring because the value was consistently around 200 mg/dL (11.1 mmol/L).

Which of the following is the most appropriate next step in helping this patient manage his diabetes?

A. Assess his greatest concerns about his health at this time

B. Refer him to a diabetes self-management education program

C. Refer him to a smoking-cessation program

D. Prescribe walking 30 minutes 5 days per week