Chapter 2: Translating the Evidence: Patient Cases
Case 1:
A 47-year-old man referred for evaluation of obesity, type 2 diabetes and dyspnea on exertion. After talking to him, you make some important notes about his medical history (shown below):
- HS graduation weight: 162 lb., BMI – 23.2 kg/m2
- Active during college but then took a sedentary job, began eating excessively, was less active and gained ~40 lb. over 15 years.
- T2DM diagnosed at age 42 when weight was 232 lb., BMI 33.3 kg/m2
- Developed left arm pain while bowling 2 years ago and had a PCI + drug-eluting stent.
- Hypertensive since college but untreated until his PCI.
- Multiple self-prescribed lifestyle attempts at weight loss have failed and he’s not sought help.
- Family history + for T2DM but only late onset ASCVD.
- Over the past 2-3 weeks he has noticed some dyspnea while walking the dog.
- Works a sedentary job as a computer analyst.
- No tobacco, 3 beers on weekends.
- Diet – 2 servings of fruits and vegetables & 1 serving of whole grains daily, fish once weekly. Doesn’t read food labels and watches CHO intake but not sodium.
- Exercise – walks the dog ~15 min twice daily.
Current Medications
Lisinopril
40 mg daily
Aspirin
81 mg daily
Atorvastatin
40 mg daily
Metformin
1700 mg AM, 850 mg PM
Sitagliptin
100 mg daily
