This article originally posted 09 August, 2009 and appeared in Issue 481
Test Your Knowledge #481: A 56-year-old woman who has Type 2 diabetes asks her physician to refer her for
A 56-year-old woman who has Type 2 diabetes asks her physician to refer her for bariatric surgery. She has had diabetes for 16 years and has been treated with metformin and insulin. She also takes atorvastatin.
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Her total cholesterol is 170 mg/dL (4.4 mmol/L), LDL cholesterol is 110 mg/dL (2.84 mmol/L), and hemoglobin A1c value is 6.1%. She has gained 1 to 2 kg (2.2 to 4.4 lb) each year since she started taking insulin. Her current body mass index is 36. She says she has been overweight since she was an adolescent and is now “desperate to lose weight.”
Which of the following actions should be taken before referral for bariatric surgery?
A. Check with the patient's insurer for referral requirements for bariatric surgery coverage.
B. Refer for assessment of cardiac risk associated with surgery.
C. Refer to a dietitian for medical nutrition therapy.
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