MKSAP: 52-year-old woman with type 2 diabetes mellitus

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg (7 lb) by making changes to her diet and activity level. Review of her blood glucose log for the past 2 weeks shows preprandial blood glucose values in the 150 to 160 mg/dL (8.3-8.9 mmol/L) range and several 2-hour postprandial blood glucose values of 190 to 200 mg/dL (10.5-11.1 mmol/L). Her only other medical problem is hypertension for which she takes lisinopril. On physical examination, blood pressure is 125/70 mm Hg and pulse rate is 74/min. BMI is 28. There is no evidence of diabetic retinopathy. She has normal monofilament and vibratory sensation in her extremities. Except for her blood glucose parameters, basic laboratory studies obtained at the time of her initial diagnosis were normal. In addition to continuing lifestyle modifications, which of the following is the most appropriate management for this patient’s diabetes? A. Initiate dapagliflozin B. Initiate glipizide C. Initiate metformin D. Initiate sitagliptin Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide....
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Diabetes Endocrinology Source Type: blogs