MKSAP: 64-year-old man with diabetes

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type 2 diabetes mellitus in his mother and hypertension and chronic kidney disease in his father. Medications are metformin, glipizide, hydrochlorothiazide, lisinopril, and atorvastatin. On physical examination, patient is afebrile, and blood pressure is 132/75 mm Hg. BMI is 30.6. He has acanthosis nigricans at the nape and scattered skin tags on the torso and neck. Laboratory studies are significant for a HbA1c level of 8.1%, a plasma glucose level of 189 mg/dL (10.5 mmol/L), and an estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m2. Sitagliptin was added to his regimen. According to a study in The BMJ, in addition to initiating sitagliptin, which of the following is the most appropriate treatment for this patient? A. Continue glipizide dose B. Decrease glipizide dose C. Increase glipizide dose D. Increase metformin dose Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Diabetes Endocrinology Source Type: blogs