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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 57-year-old Black man presents for primary care follow-up after a recent urgent care visit due to polyuria approximately 1 month ago. In urgent care, he was found to have a blood glucose of 287 mg/dL and an A1C of 9.5%. His ketones were negative. The test reports were as follows: aspartate aminotransferase 15 U/L, alanine aminotransferase 40 U/L, and blood pressure 128/72 mm Hg. At that encounter, he was given metformin 500 mg twice daily and insulin glargine 10 units at bedtime and instructed to follow up with his primary care provider. Before this incident, his medical history included prediabetes, obesity (BMI 32 kg/m2), osteoarthritis, and hypertension, and medications included lisinopril 20 mg daily and acetaminophen 500 mg twice daily.

Current presentation

The patient provides a fasting blood glucose log showing an average blood glucose of 190 mg/dL. He reports tolerating metformin well and states that he is willing to take an injectable medication but frequently forgets to inject his nightly insulin. He denies symptoms of hypoglycemia and states that he is interested in the medications he has seen on TV that help with diabetes and weight loss. He has been trying to lose weight with lifestyle changes including eliminating simple sugars and walking 3-4 times weekly since his type 2 diabetes (T2D) diagnosis but has not been successful. His current vitals are as follows: blood pressure 127/70 mm Hg, pulse 72 beats/min, height 5′10″, weight 223 lb, waist circumference 40″. Recent labs show a urine albumin–to-creatinine ratio of 20 mg/g, an estimated glomerular filtration rate of 85 mL/min/1.73 m2, total cholesterol 240 mg/dL, low-density lipoprotein 136 mg/dL, high-density lipoprotein 40 mg/dL, and triglycerides 250 mg/dL. All other labs are within normal limits.

 

You determine this patient’s A1C goal to be <7%. You decide to increase metformin to 1000 mg twice daily since the patient is tolerating it well and refer the patient to a diabetes educator for additional counseling on lifestyle changes including diet and exercise. You also start atorvastatin 40 mg daily to lower his cholesterol.

Which of the following additional interventions would be best for this patient at this time to improve blood glucose control and assist with weight management?