Case Presentation: A Patient With Type 2 Diabetes

Abstract

A Patient With Type 2 Diabetes T he following case presentation illustrates how long-acting glucagon-like peptide 1 (GLP-1) agonists, such as exenatide, or dipeptidyl peptidase 4 (DPP-4) enzyme inhibitor incretin enhancers, such as sitagliptin or, in the future, vildagliptin, may play a role in the treatment of patients with type 2 diabetes, a disorder of β-cell dysfunction.The patient is a 48-year-old man with a 4-year history of type 2 diabetes who presents for a follow-up evaluation. Initially, he has no complaints, but he later admits to shortness of breath. He claims that he follows his diet and exercises sporadically. He does not routinely perform self-monitoring of blood glucose (SMBG). At the time of his original diagnosis 4 years earlier, his fasting plasma glucose ranged from 114 mg/dL (6.3 mmol/L) to 141 mg/dL (7.8 mmol/L), his A1C level was 7.2%, and he was participating in both diabetes education and nutrition counseling. Although he initially lost weight, he claims he has gained 10 lb in the past year. He is a social drinker with a 30-pack-year smoking history and a strong family history of diabetes. His father died of myocardial infarction at the age of 55 years. The patient's past medical history includes hypertension, dyslipidemia, diabetes, and osteoarthritis. His medications are metformin, 500 mg twice a day, as well as daily doses of hydrochlorothiazide 12.5 mg, atorvastatin 10 mg, and ibuprofen. On physical examination, his major abnormality is blood pressure of 140/90 mm Hg, which is above the goal for a patient with diabetes. The patient's body mass index (BMI) is currently 34.5 kg/m 2 . His A1C level is 7.7%, and his fasting plasma glucose level is 138 mg/dL (7.6 mmol/L). He has elevated low-density lipoprotein (LDL) cholesterol and triglycerides and low high-density lipoprotein (HDL) cholesterol. Remaining laboratory study results are within normal limits.Lawrence Blonde, MD, FACP, FACE