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Clinical Case: 47 Year-Old Clerk

Patient Background

47 year-old African-American woman with three children and one unsuccessful pregnancy. She has a full-time clerical job for a transportation company. On her last pregnancy five years ago, she had gestational diabetes. No other significant history.

She returns for her annual check-up. Her lab tests were drawn pre-visit.

Gender: Female
Age: 47
Weight: 192 lbs.
Height: 5' 4"
BMI: 33

Glucose Monitoring
Last A1C: 8.5%
Fasting: 235 mg/dL
Pre-prandial:
Post-prandial:

Lipid Profile
Total: 215 mg/dL
LDL: 135 mg/dL
HDL: 53 mg/dL
Triglycerides: 130

Kidney Profile
Creatinine: 0.9 mg/dL
Microalbuminuria: none

Liver Function
ALT: normal
AST: normal

Blood Pressure
Normal: 126/78 mmHg

Cardiovascular condition
within normal limits

Eye Exam
Normal

Foot Exam
Normal pulses and sensation


Compliance with meal plan? Does not follow any specific meal plan. Interview reveals that she tends to cook a high-fat diet with a large amount of fried foods.	Compliance with exercise plan? Does not exercise regularly.


For blood glucose: none	For other conditions: none

African-American women are at higher risk for type 2 diabetes. Together with her gestational diabetes and obesity, type 2 diabetes is a strong likelihood.

The American Diabetes Association recommends repeating the fasting blood glucose to confirm the diagnosis of diabetes. Some physicians faced with a patient who has an elevated A1c and high blood glucose may choose to initiate therapy without repeating the lab tests.

How would you initially treat this patient?
	Diet and exercise alone
	Diet and exercise plus an oral agent
	Diet and exercise plus an incretin mimetic
	Diet and exercise plus insulin

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