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PATIENT PRESENTATION

Chief Complaint

“My primary care provider told me I need to lose weight and manage my diabetes better. She also told me that my blood pressure was high at my last visit and that diabetes and heart disease are connected. I did not know that. I’m feeling okay in general, but I am disgusted with gaining weight and being tired all the time.”

History of Present Illness

NH is a 46-year-old woman who presents to the community pharmacy/clinic complaining about her weight and fatigue. She is adherent to her primary care provider (PCP) appointments every 3 months since she was diagnosed with T2DM 1 year ago. She is aware that her blood glucose and A1c are not at goal, her blood pressure is starting to rise, and she needs to better manage her diabetes and its related conditions. She states that she takes her medications daily as prescribed and only misses an occasional dose (about 2-3 per month). She checks her fasting blood glucose almost every day. She tries to eat healthy, but occasionally “cheats,” especially during holiday seasons. She walks 3 to 4 days per week for 20 to 30 minutes, depending on the weather. She also comments on occasional ringing in her ears.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

TARGETED QUESTIONS

  1. What signs and symptoms is the patient experiencing that indicate her diabetes in not controlled?

    Hint: See Clinical Presentation and Diagnosis in PPP

  2. What diabetes-related macrovascular conditions does the patient have?

    Hint: See Treatment in PPP

  3. What diabetes-related microvascular complications does the patient have?

    Hint: See Treatment in PPP

  4. What are the therapeutic goals for this patient?

    Hint: See Table 44-6 in PPP

  5. What modifications should be made to her drug therapy and diabetes self-management plans?

    Hint: See Figure 44-2 in PPP

FOLLOW-UP

How should the patient’s therapeutic plan be monitored?

Hint: See Table 44-13 in PPP

CASE SUMMARY

Global Perspective

Type 2 diabetes mellitus (T2DM) is growing at an epidemic rate. More than 37 million people have diabetes and 96 million have prediabetes in the United States. New diabetes cases were higher among non-Hispanic blacks and people of Hispanic origin. Racial and ethnic minorities continue to develop T2DM at higher rates. Risk of diabetes increases with age, with 26.4% among those aged 65 years or older. However, there is an uptick in new cases of youth developing type 1 diabetes and T2DM. Additionally, greater than 89% of people with T2DM were overweight or obese. Approximately 27% were overweight (with a ...

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