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Yearly Archives: 2018

Clinical Case Vignette: Treatment Next Steps

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? A. Encourage lifestyle modifications and start metformin with an A1C target of < 7.0%.
B. Encourage lifestyle modifications and start metformin with an A1C target of < 6.0%.
C. Encourage lifestyle modifications and do not initiate drug therapy at this time.
D. Encourage lifestyle modifications and start metformin and a sulfonylurea.
Follow the link for the answer.

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Treatment Backup Plan

What is your choice for a second drug after metformin for your type 2 patients with an A1c of 8 or above and 25 pounds overweight? DPP-4 GLP-1 SGLT-2 Insulin Other Follow the link to share your opinion.

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May 15, 2018

One of the ways that we look at the onset of type 2 diabetes is in the destruction of beta cells in the pancreas. We know that in type 1 diabetes a major autoimmune event occurs, destroying the beta cells. When a patient who has type 2 diabetes has to …

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