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Diabetes Clinical Case: 54 Year-Old Lawyer

Patient Background

54 year old male lawyer has had high blood glucose for over a year, but only now after a random reading exceeds 300 mg/dL on an office visit is he willing to admit that he has diabetes.

He has had a previous heart attack and is taking several cardiovascular and hypertensive medications.

His physical exam today is normal. He has a BMI of 28. He admits to feeling a little tired, recently, and has been getting up at night to urinate at least two to three times per week.

Age: 54
Weight: 212 lbs.
Height: 6' 1"
BMI: 28

Blood Glucose
Last A1C: 10.2%

Fructosamine: 429 mmo/L
(nl <250)

Random: 358 mg/dL

Lipid Profile
Total: 153 mg/dL
LDL: 70 mg/dL
HDL: 41 mg/dL
Triglycerides: 225 mg/dL

Kidney Profile
Creatinine: 0.8 mg/dL

Microalbuminuria:
negative

Liver Function
ALT: normal
AST: normal

Blood Pressure
Normal: 130/90 mmHg

Cardiovascular condition Previous myocardial infarction

Eye Exam
Normal

Foot Exam
Normal pulses and sensation


Compliance with meal plan? No diabetes meal plan at this time.	Compliance with exercise plan? Limited activity and rare exercise.

For blood glucose: none	For other conditions: HCTZ, 25 mg qd Metoprolol (Toprol XL), 50 mg qd Aspirin 81 mg qd Simvastin (Zocor) 20 mg qd

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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