MSN5600L Case Study 3: Holistic Management of Type 2 Diabetes with Comorbidities
Patient Profile: Sarah, a 55-year-old woman, presents to her primary care nurse practitioner with complaints of increased thirst, frequent urination, and fatigue over the past few weeks.
She has a family history of type 2 diabetes mellitus (T2DM), with her father and two siblings diagnosed with the same condition. She has a BMI of 30.9 and a sedentary lifestyle. Laboratory tests reveal elevated fasting blood glucose levels of 140 mg/dL, an HbA1c of 8.5%, and a total cholesterol level of 207 mg/dL, and triglycerides of 158 mg/dL Her blood pressure measures is
135/78 mmHg, Case Scenario: Sarah is your patient now, and you have just diagnosed her with type 2 diabetes.
You (as her PCP) initiate a comprehensive treatment plan according to the latest guidelines to mitigate long-term complications.
Questions:
1. According to the latest guidelines, what would be the initial pharmacologic and nonpharmacological treatment for Sarah’s type 2 diabetes?
2. According to the latest guidelines, what additional preventive (pharmacological and nonpharmacological) measures would need to be taken to mitigate Sarah’s risk of cardiac
consequences, considering her lipids and hypertension state?
3. Which referrals, if any, would be necessary for Sarah’s comprehensive management, and what specific assessments or interventions would these referrals entail?
4. When would you recommend scheduling Sarah for a follow-up appointment to assess her response to treatment ?
Case Study 3: Holistic Management of Type 2 Diabetes with Comorbidities
Patient Profile:
Sarah, a 55-year-old woman, presents with classic symptoms of type 2 diabetes mellitus (T2DM), including increased thirst, frequent urination, and fatigue. Her family history and laboratory tests solidify the diagnosis, revealing elevated blood glucose, HbA1c, cholesterol, and triglycerides, alongside elevated blood pressure.
Case Scenario:
As Sarah’s primary care provider (PCP), you are tasked with initiating a comprehensive management plan to optimize her health outcomes and prevent long-term complications associated with T2DM and its comorbidities. This involves a combination of pharmacological and non-pharmacological interventions.
1. Initial Treatment for Type 2 Diabetes:
Current guidelines from the American Diabetes Association (ADA) and the European Society for the Study of Diabetes (EASD) advocate for a multifaceted approach to managing T2DM, emphasizing both lifestyle modifications and medications [1, 2].
Non-pharmacological interventions:
Lifestyle modifications: The cornerstone of T2DM management involves sustainable lifestyle changes, including dietary modifications promoting weight loss, regular physical activity, and smoking cessation [1, 2].
Dietary therapy: A registered dietitian can tailor a meal plan to promote weight management and glycemic control, considering Sarah’s preferences and cultural context [1].
Physical activity: Engaging in moderate-intensity aerobic activity for at least 150 minutes or vigorous-intensity activity for 75 minutes per week, alongside strength training exercises twice a week, is recommended [1, 2].
Pharmacological interventions:
The choice of initial medication is individualized based on factors like glycemic control, comorbidities, and patient preferences. Metformin is typically the first-line therapy due to its efficacy, safety profile, and cost-effectiveness [1, 2]. Other oral medications or injectable therapies may be added if glycemic targets are not achieved with metformin alone.
2. Management of Cardiovascular Risk:
Sarah’s lipid profile and blood pressure indicate an increased risk of cardiovascular complications. Therefore, addressing these risk factors is crucial.
Non-pharmacological interventions:
Lifestyle modifications: The same healthy lifestyle changes recommended for glycemic control can significantly improve cardiovascular health [3].
Pharmacological interventions:
Statin therapy: High-intensity statin therapy is recommended for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in individuals with diabetes like Sarah, even with normal LDL-C levels [3].
Blood pressure control: Lifestyle modifications are crucial for managing blood pressure. If these are insufficient, antihypertensive medications are initiated, targeting a blood pressure goal of less than 130/80 mmHg [4].
3. Referrals for Comprehensive Management:
A multidisciplinary approach is essential for Sarah’s comprehensive care. Referrals to the following specialists may be necessary:
Registered dietitian: For ongoing support with dietary modifications and meal planning.
Diabetes educator: To provide education on self-management skills, including glucose monitoring, medication administration, and foot care.
Cardiologist: To assess her cardiovascular risk profile in detail and guide further management strategies.
4. Follow-up Appointments:
Close monitoring is vital to assess treatment response and identify potential complications. The recommended follow-up schedule is individualized based on various factors, but typically involves appointments every 1-3 months in the initial stages, with intervals gradually increasing as glycemic control and risk factors improve [1, 2].
In conclusion, Sarah’s case highlights the importance of a comprehensive approach to managing T2DM and its associated comorbidities. By combining lifestyle modifications, evidence-based medications, and specialist consultations, healthcare providers can empower patients like Sarah to achieve optimal health outcomes and prevent long-term complications.
Bibliography:
American Diabetes Association. 2023 Standards of Medical Care in Diabetes. Diabetes Care 47 (Supplement 1) (2024): S1-S398 [2]
European Society for the Study of Diabetes, American Diabetes Association. 2023 Guidelines for the management of type 2 diabetes. Diabetologia 66 (2023): 1035-1087 [3]
Grundy SM et al. AHA/ACC/AACVPR/AHelp write my thesis – APA/ABC/ACPM/ADA/AGS/AHA/APHA/ASPC/BAI/ACC/BSC/BVM/CVS/FHRL/NHLBI/PCNA/SAHF/SCCT/STS/SVM/TUAC/VA/AACC/AHA/ASA/CAPC/EOLC/HFSA/HRS/IABP/ISPAH/NCC/NHLBI/SCCT/SCMR/S
