Question

AR is a 46yo African-American male who presents to his doctor with excessive thirst, urination, and hunger for the past 2 months. Other past medical history includes obesity, hypertension, hyperlipidemia, and occasional tension headaches. He is a non-smoker and participates in minimal weekly cardiovascular activity. He is currently taking hydrochlorothiazide 25mg daily, atorvastatin 20mg QHS, acetaminophen 500mg daily PRN pain. Pt denies any drug allergies. His doctor draws fasting labs with the following results: Glucose 168, Scr 1.01, BUN 14, Hemoglobin A1c 7.4, TSH 1.23, Total Cholesterol 208, LDL 165, and HDL 42. Vitals include: BP- 145/83, HR- 78bpm, temp- 98.6, height 65 inches, and weight 85kg. He is diagnosed with type 2 diabetes.

1. What medication would likely be started as first line therapy in this patient to treat his diabetes?

Metformin

Sitagliptin

Saxagliptin

Pioglitazone

2. What would be the starting dose of medication answer from Question #1? (select all that apply)

500 mg daily 1250 mg ER daily 500 mg twice daily (immediate release) 1250 mg ER twice daily

1250 mg ER daily

500 mg twice daily (immediate release)

3. The doctor discusses with AR the long term risks of his diabetes for increasing his risk of having a heart attack or stroke. The doctor calculates his atherosclerotic Cardiovascular Disease Risk score. What is his current cardiovascular 10 year risk? What would be his cardiovascular 10 year risk if risk factors were optimal?

Hint: http://tools.acc.org/ldl/ascvd_risk_estimator/index.html#!/calulate/estimator/ (Links to an external site.)Links to an external site.

0%, 10%

17.5%, 3.2%

13%, 15.4%

75%, 60%

4. At 3 months follow-up, remarkable labs include fasting glucose 157, A1c 7.2. Patient with no problems tolerating current medication. What would be next line therapy?

Stop current DM medication

Increase dose of current DM medication

Add on another oral DM medication from a different class

Add short-acting insulin after breakfast

5. What may be some common side effects AR may experience with his current DM treatment? Choose all that apply.

Diarrhea

Stomach discomfort

Hypoglycemia

Hypertension

Neuropathy

Answer 1

1. Metformin

The first- line drug for managing type 2 diabetes is Metformin.

2. 500 mg daily.

The initial dose might be 500 mg once daily with the evening meal.

3. 17.5% , 3.2%

Current 10 year ASCVD Risk is 17.5%

Optimal ASCVD Risk is 3.2%

4. Increase dose of current DM medication.

Patient is tolerating with current medication and no much problems are reporting

5. Diarrhoea

Stomach discomfort

Hypoglycemia. ( these are the common side effects of Metformin)