Case Study 3: Holistic Management of Type 2 Diabetes with Comorbidities
Patient Profile: Sarah, a 55-year-old woman, presents to her primary care nurse practitioner
with complaints of increased thirst, frequent urination, and fatigue over the past few weeks.
She has a family history of type 2 diabetes mellitus (T2DM), with her father and two siblings
diagnosed with the same condition. She has a BMI of 30.9 and a sedentary lifestyle. Laboratory
tests reveal elevated fasting blood glucose levels of 140 mg/dL, an HbA1c of 8.5%, and a total
cholesterol level of 207 mg/dL, and triglycerides of 158 mg/dL Her blood pressure measures is
135/78 mmHg,
Case Scenario: Sarah is your patient now, and you have just diagnosed her with type 2 diabetes.
You (as her PCP) initiate a comprehensive treatment plan according to the latest guidelines to
mitigate long-term complications.
Questions:
1. According to the latest guidelines, what would be the initial pharmacologic and nonpharmacological treatment for Sarah's type 2 diabetes?
2. According to the latest guidelines, what additional preventive (pharmacological and nonpharmacological) measures would need to be taken to mitigate Sarah's risk of cardiac
consequences, considering her lipids and hypertension state?
3. Which referrals, if any, would be necessary for Sarah's comprehensive management, and
what specific assessments or interventions would these referrals entail?
4. When would you recommend scheduling Sarah for a follow-up appointment to assess
her response to treatment ?
Sample Solution
1. Initial Pharmacologic and Nonpharmacological Treatment:
Nonpharmacological:
- Lifestyle modifications: This is the cornerstone of diabetes management. Sarah needs to adopt a healthy diet, increase physical activity (aim for at least 150 minutes of moderate-intensity exercise per week), and maintain a healthy weight.
- Patient education: Sarah should receive comprehensive education on diabetes, including self-monitoring of blood glucose (SMBG), healthy eating, physical activity, medication management, and potential complications.
Full Answer Section
Pharmacological:
- Metformin: This is the first-line medication for most patients with T2DM due to its effectiveness, safety, and cost-effectiveness. It improves insulin sensitivity and reduces blood sugar levels.
- Additional medication: Depending on Sarah's response to metformin and individual factors, other medications like GLP-1 receptor agonists, SGLT2 inhibitors, or DPP-4 inhibitors might be considered.
2. Preventive Measures for Cardiac Consequences:
Pharmacological:
- Statin: Given Sarah's elevated cholesterol, a statin to lower LDL cholesterol is recommended.
- Antihypertensive medication: With her blood pressure reading of 135/78 mmHg, monitor closely. If it consistently remains above 130/80 mmHg, consider an antihypertensive medication according to individual factors and guidelines.
Nonpharmacological:
- Continue healthy lifestyle modifications: Maintaining a healthy diet, exercising regularly, and managing weight are crucial for managing cholesterol and blood pressure.
- Smoking cessation: If applicable, encourage Sarah to quit smoking as it significantly increases cardiovascular risk.
3. Referrals:
- Dietician: A registered dietitian can help Sarah create a personalized meal plan that meets her nutritional needs and preferences.
- Diabetes educator: A certified diabetes educator can provide further education and support on managing her diabetes effectively.
- Cardiologist: Depending on her risk factors and response to initial interventions, a referral to a cardiologist might be needed for further assessment and management of her cardiovascular risk.
4. Follow-up Appointment:
- Schedule Sarah for a follow-up appointment within 1-2 weeks to assess her response to initial treatment, provide further education, and adjust medications as needed.
- Subsequent follow-up intervals will be determined based on her progress and individual needs, typically ranging from 3-6 months.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Always consult with a healthcare professional for diagnosis and treatment planning.
Remember, this is a general treatment plan and may need to be adjusted based on Sarah's individual needs and the specific recommendations of her healthcare provider.