Diabetes Quiz: A 79-Year-Old With Elevated AlC Who Has Had a Stroke: How Would You Treat?

The elderly patient has had type 2 diabetes for 15 years is now home bound after a stroke. Her HbA1c is 9.6 and she takes only metformin. Review the rest of her laboratory results and propose a management plan.

Sue Jones, 79-years-old, has had type 2 diabetes for 15 years. She is home-bound after a recent stroke and now requires assistance with most of her activities. She has a daytime sitter and a weekly visiting nurse; her family provides care in the evenings and on weekends. The family has moderate means and would like to keep her at home. Sue can communicate effectively: she recognizes all of her family members and you, as her physician.

Her most recent lab tests showed an HbA1c of 9.6; a random blood sugar of 450; triglycerides, 350 mg/dL; HDL, 40; LDL, 110 (calculated); total cholesterol, 220; and non-HDL,180.

Some of her medications were stopped when she was discharged from the hospital 3 weeks ago. She now only takes metformin (2000 mg/d) for her diabetes and no medications for her lipids.

Would you consider more aggressive treatment of her elevated HbA1c? If so, why-and with what medications? What goals would you have for her A1C? Would you do anything to treat her lipids?

Please add your comments below-including your agreements and disagreements.Dr. Shahady he will respond to the comments made within the next 2 weeks.
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