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Live Interactive Cases: Weight and T2D
Live Interactive Case Challenge: Shifting the Treatment Paradigm of Weight Management and T2D in Primary Care

Released: June 07, 2023

Expiration: June 06, 2024

Martin J. Abrahamson
Martin J. Abrahamson, MD, FACP
Debbie Hinnen
Debbie Hinnen, APN, BC-ADM, CDCES, FAAN
Activity Information

Activity

Progress
1
Course Completed

History

A 68-year-old Hispanic woman with a past medical history of T2D (diagnosed 4 years ago), obesity, a history of myocardial infarction (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 for the past 3 months. She has been meeting with a dietitian and has been following a diet recommended for T2D and heart health, including 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 extended release (ER) 20 mg daily. She also receives 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 her fasting blood glucose readings have been well controlled and denies signs or symptoms of hypoglycemia. Her current vitals are as follows: blood pressure 131/82 mm Hg, pulse 68 beats/min, height 5′4″, weight 195 lb, BMI 33.5 kg/m2, and waist circumference 37″. 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 <7.5%. You decide to continue metformin since 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 also is one of your patients.

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