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VOLUME 1 ISSUE 2 CASE WM	WM is a 55-year-old man with new onset diabetes.
CHIEF COMPLAINT WM complains of polydipsia, fatigue, and polyuria. LABORATORY VALUES »  Fasting glucose: 256 mg/dL »  Fasting C-peptide: 8 ng/dL (normal: <5) »  A1c: 9.2 % »  Blood pressure: 145/90 mm Hg »  Lipid profile   --  Total cholesterol: 233 mg/dL   --  Triglycerides: 360 mg/dL   --  High-density lipoprotein: 21 mg/dL   --  Calculated low-density lipoprotein: 132 mg/dL   --  Non-HDL cholesterol: 212 mg/dL PROBLEMS This patient displays several features typical of type 2 diabetes, including: 1. Uncontrolled hyperglycemia 2. Moderate hypertension 3. Dyslipidemia NAVIGATION »  Q1: What is your first step? »  Q2: What is your initial treatment plan to manage this patient’s hyperglycemia and dyslipidemia? »  Q3: How would you characterize WM’s cardiovascular risk based on this lipid profile? »  Q4: How could you further characterize WM’s lipid profile? »  Q5: What pharmacologic interventions can increase total HDL and HDL2? »  Q6: What are the expected results if a TZD and statin are used in combination? »  Q7: What other changes, if any, do you make in WM’s treatment plan? »  Q8: What are the advantages and disadvantages of adding a fibrate or niacin? »  Q9: You decide to add fenofibrate 54 mg/d to target triglycerides and HDL-C. What should you do if WM reports suggestive muscle symptoms?	Q: What is your first step? A: Interventions to improve glycemia are key for initial management in patients with type 2 diabetes and dyslipidemia. Lowering plasma glucose will, in turn, lower triglyceride levels. In general, glucose lowering agents do not change or have only a modest effect on raising HDL-C levels, but even a small increase in HDL-C is beneficial.1 In addition, some agents, such as the thiazolidinediones (TZDs), may alter the HDL-C composition in a direction thought to be antiatherogenic.2 Lowering of glucose has little or no effect on LDL-C, so a statin should be started right away.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.tju.edu/jeffcme
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