DM 2023 Cases.pdf

Non-Insulin Therapies: Cases Andrea Levin, PharmD, CPh, BCACP Assistant Professor, Nova Southeastern University College of Pharmacy 2023 Case 1: LR is a 52 YOF who presents to clinic for her physical No PMH Pertinent labs include: HbA1c: 5.9% FBG: 110 mg/dl How would you classify this patient and wh...

Non-Insulin Therapies: Cases Andrea Levin, PharmD, CPh, BCACP Assistant Professor, Nova Southeastern University College of Pharmacy 2023 Case 1: LR is a 52 YOF who presents to clinic for her physical No PMH Pertinent labs include: HbA1c: 5.9% FBG: 110 mg/dl How would you classify this patient and when should they follow up for another HbA1c? Case 1: One Year Later LR is a 53 YOF returns 1 year later for follow up Pertinent labs include: HbA1c: 7.8% FBG: 150 mg/dl How would you classify this patient and when should they follow up? Case 1: Back to LR (and we have labs!!!) LR is a 53 YOF returns 1 year later for follow up Pertinent labs include: 150 HbA1c: 7.8% What is your recommendation? GFR: 96 mL/min/1.73m2 Treatment? Follow up? Case 1: Three Years Later… LR is a 56 YOF returns for follow up three years later Metformin 1000 mg BID Pertinent labs include: HbA1c: 8% BMI: 32 kg/m2 2 GFR: 68 mL/min/1.73m What would you recommend? Treatment? Follow up? LR: Additional Considerations ▪ What if LR’s GFR decreased to 40 ml/min/1.73m2? ▪ What if LR’s GFR decreased to 28 ml/min/1.73m2? Case 2: MG is a 43 YOF who presents to clinic with a PMH of T2DM Her current medications include: metformin 500 mg BID x 6 months Pertinent labs include: 140 HbA1c: 7.2% GFR: 88 mL/min/1.73m2 What would you recommend? Case 3 BH is a 53 YOM who presents to clinic with a PMH of T2DM and HF His current medications include: metformin 1000 mg BID, Entresto 97-103 mg BID, Toprol XL 50 mg daily HbA1c: 7.8% What would you recommend? GFR: 92 mL/min/1.73m2 Case 3: GS is a 45 YO AAM with newly diagnosed T2DM and HTN Pertinent labs include: HbA1c: 8.2% BMI: 31 kg/m2 BP: 138/86 (HR 76bpm) ASCVD 10 year risk: 22% Insurance: BCBS PPO Branded Products ($25 copay) GFR: 96 mL/min/1.73m2 ACR: 2 mg/g Fasting Lipids: TC- 196 mg/dl LDL-120 mg/dl TG-225 mg/dl HDL- 31 mg/dl Case 4: 2.4 ML is a 65 YO Hispanic female with GFR: 34 mL/min/1.73m2 newly diagnosed T2DM ACR: 450 mg/g PMH significant for HTN, CKD, MI, and dyslipidemia Current meds: amlodipine 10 mg qday, Toprol XL 50 mg qday, atorvastatin 20 mg qday HbA1c: 8.3% BMI: 33 kg/m2 Fasting Lipids: BP: 136/86 (HR 54 bpm) TC- 181 mg/dl LDL-86 mg/dl Insurance: BCBS PPO Branded Products ($25 copay) TG- 320 mg/dl HDL- 31 mg/dl Case 5 LM is a 36 YOM who presents to clinic with a PMH of T2DM His current medications include: metformin 1000 mg BID HbA1c: 7.8% Insurance: Self-pay GFR: 92 mL/min/1.73m2 ACR: 10 mg/g