Diabetes is a progressive disease and takes advantage of inaction. How would you manage our patient Mrs Davis?
Meet your patient Mrs Davis. 48 y/o, T2DM, HTN, hyperlipidemia, obesity; takes metformin, BP meds, statin, baby aspirin.
First steps with new T2DM patient Mrs Davis: Counsel her on weight loss, send to CDE, refill Rx and testing supplies, remind her to bring glucometer/log book to next appointment, in 3 months.
Three-month T2DM follow-up: Mrs Davis has lost 4 lbs; BP is range; typical FPG 160-130; average blood sugar/30 days per meter is 189; she is encouraged to keep up the good work.
Six-month T2DM follow-up from initial visit: BP is increased (142/92 mmHg); she has regained weight she lost; A1c is 8.4; LDL is 132; she says she is really trying; she is counseled again on changing lifestyle habits to improve her health
Re-evaluating T2DM/comorbidity management. Over the course of 6 months, Mrs. Davis’ T2DM, HTN, LDL-C have gotten worse. How could the progressive decline have been prevented?
Clinical inertia in action: A1c. Blood sugar average at visit 1, 177; first follow-up, 30-day average SMBG was 189; repeat A1c at 6 months was 8.4 (up from 7.8). When should T2DM treatment have been intensified?
Clinical inertia in action: BP. Mrs Davis' blood pressure was initially within goal range; at 3 months was a top of the range, at 6 months, above goal. Optimally, when should HTN meds been adjusted?
Clinical inertia in action: LDL. LDL-C at presentation was 108, close to top of goal range; at 6 months it was 132. When should her statin have been increased?
Clinical inertia in action. Inertia is defined as "a tendency to remain unchanged." Medical management and lifestyle interventions should have been assessed/intensified at the initial or at least at 3-month follow-up.
After a diagnosis of type 2 diabetes, clinician and patient alike are challenged to keep pace with and, ideally stay ahead of, the progressive Ã-cell deterioration that underlies diabetes pathophysiology. Find out how Mrs Davis and her doctor get started.