Nu610diabetespeerresponse#1

Subjective:

A 16-year-old female, newly diagnosed with type 2 diabetes, is active, playing as the goalie for her high school soccer team. Her BMI is calculated to be 37, classifying her as obese.

Objective:

Physical Examination:

BMI: 37
Blood pressure, heart rate, respiratory rate, and temperature are within normal limits.

Laboratory results:

Fasting blood glucose: Elevated
Hemoglobin A1c: Elevated

Assessment:

Newly diagnosed type 2 diabetes mellitus

Plan:

Diagnostics:

A comprehensive metabolic panel (CMP) should be ordered to evaluate kidney function, liver function, and electrolyte levels. Together, a urinalysis is essential to detect the presence of proteinuria or microalbuminuria, indicators of potential nephropathy. Given the prevalence of dyslipidemia in T2DM patients, a lipid panel is crucial for monitoring cholesterol levels. As highlighted by Latha et al. in 2023, consistent surveillance for dyslipidemia is paramount in T2DM patients due to their increased susceptibility to cardiovascular diseases. Additionally, assessing TSH and free T4 levels is recommended to rule out any coexisting thyroid dysfunction.

Therapeutics:

Starting metformin therapy is recommended as the first-line treatment for T2DM unless contraindications exist. The dosage should be tailored, considering the patient’s tolerance and renal function. As emphasized by Das et al. in 2021, metformin is particularly beneficial because it proficiently achieves glycemic control with minimal associated risks. If the lipid panel results indicate a need, initiating a statin can be considered to mitigate cardiovascular risks. Alongside these therapeutic measures, it’s paramount to emphasize the importance of lifestyle changes. This encompasses adopting a structured weight loss program and amplifying physical activity levels.

Educational:

Educating patients about the critical role of blood glucose monitoring is essential, highlighting its frequency and the target levels they should aim for. Equally vital is a discussion on the importance of a balanced diet, which includes counting carbohydrates and grasping the concept of the glycemic index. As pointed out by Petroni et al. in 2021, the optimal nutritional strategy revolves around maintaining or achieving a body weight within the standard parameters. Simultaneously, it’s crucial to ensure the proper intake of both macronutrients and micronutrients to mitigate the risk of sarcopenia. Also, patients should be reminded of the significant advantages of physical activity, particularly its instrumental role in managing blood glucose levels.

Consultation/Collaboration:

Refer to a registered dietitian for individualized meal planning and dietary guidance.
Consult with an endocrinologist for specialized care and management strategies. HbA1c, blood pressure, and weight management can all improve with integrated interventions and an engaged endocrinologist (Zarora et al., 2022).
Consider referral to a behavioral therapist or psychologist to address any emotional or mental health concerns related to the diagnosis.

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