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Weight and T2D: Case 2

CE / CME

Shifting the Treatment Paradigm of Weight Management and Type 2 Diabetes in Primary Care: Interactive Case Challenge 2

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: November 08, 2023

Expiration: November 07, 2024

CME/CE Information

Activity

Progress
1 2
Course Completed

History 
A 68-year-old Hispanic female with a past medical history of T2D (diagnosed 4 years ago), obesity, MI (3 years ago), and hyperlipidemia presents to her primary care provider for a routine follow-up.

Current Presentation 
She is frustrated about her lack of progress with weight loss following lifestyle changes over the past 3 months. She has been meeting with a dietitian and has been following a diet recommended for T2D and heart health that includes decreased sodium; decreased carbohydrates; increased protein, fruits and vegetables; and lower fat. She recently retired from her office job and has increased her exercise by walking 30 minutes per day, 4-5 days per week. Her current medications for T2D include metformin 1000 mg twice daily, saxagliptin 5 mg daily, and glipizide ER 20 mg daily. She also takes rosuvastatin 20 mg daily, losartan 100 mg daily, and metoprolol succinate 50 mg daily. She is hesitant about injectable medications because her husband started on “one of those and it made him really sick.” She reports that her fasting blood glucose readings have been well controlled and denies signs or symptoms of hypoglycemia. Her current vitals are blood pressure 131/82 mm Hg, pulse 68 beats/min, height 5 ft 4 in, weight 195 lb, BMI 33.5 kg/m2, waist circumference 37 in. Recent labs show an A1C of 7.5%, a urine albumin-to-creatinine ratio of 22 mg/g, and an estimated glomerular filtration rate of 82 mL/min/1.73 m2. All other labs are within normal limits.

You consider this patient’s A1C as well controlled to her goal of less than 7.5%. You decide to continue metformin because the patient is tolerating it well. You make a note to yourself to screen the patient’s daughter for T2D at her next visit, as she is also one of your patients.

Question 1

Which of the following would be best for this patient at this time?