University  |   Hospital  |   Pulse  |   JeffNet   |   RAP

Find People  |   JeffMail  |   JeffCal  |   JeffShare

VOLUME 1 ISSUE 4 CASE JJ	JJ is a 53-year-old man with type 2 diabetes diagnosed 15 years ago, who returns to the office for a scheduled follow-up visit.
CHIEF COMPLAINT Intermittent blurry vision CURRENT MEDICATIONS »  Glyburide 10 mg BID »  Metformin 1000 mg BID »  Fosinopril 20 mg QD FAMILY AND SOCIAL HISTORY Father had diabetes and died from heart failure. Patient is married with two grown children. REVIEW OF SYSTEMS Remarkable for polyuria 2–3 times at night and 5–6 times during the day, tingling sensation in the fingers and toes. No chest discomfort or intermittent claudication. EXAMINATION »  General:   --  temp 98.3°   --  weight 212 lb; height 5' 9"   --  pulse 70/min, regular   --  blood pressure 135/74 mm hg »  HEENT: Anicteric »  Funduscopy: Normal »  Neck: Supple, no goiter »  Chest: Clear to auscultation »  Heart: Normal findings »  Abdomen: Benign »  Neurologic: Impaired sensation to nylon filament in both feet; hypoactive tendon reflexes »  Extremities: No foot ulcer; normal foot pulses PROBLEMS »  Type 2 diabetes »  Blurry vision—probably from uncontrolled diabetes »  Diabetic neuropathy »  Hypertension—fairly well controlled NAVIGATION »  Q1: What would you do at this visit? »  Q2: How would you interpret JJ’s laboratory results? »  Q3: What factors are associated with microalbuminuria in the general population? »  Q4: What is the significance of microalbuminuria in the natural history of diabetic nephropathy? »  Q5: What are the risk factors for nephropathy in persons with diabetes? »  Q6: Is there a link between microalbuminuria and cardiovascular disease? »  Q7: What are the current methods of screening for diabetic nephropathy? »  Q8: What interventions have been proven to delay the progression of diabetic nephropathy? »  Q9: What is your overall approach to the management of JJ’s problems?	Q: What are the risk factors for nephropathy in persons with diabetes? A: Well-known risk factors for the development and progression of diabetic nephropathy include hyperglycemia and hypertension. Others include hereditary/familial factors (in certain populations), dyslipidemia (specifically, increased VLDL-triglycerides, decreased HDL-cholesterol), increased lipoprotein[a], and cigarette smoking.3,5
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.edu/jeffcme
The Thomas Jefferson University web site, its contents and programs, is provided for informational and educational purposes only and is not intended as medical advice nor is it intended to create any physician-patient relationship. Please remember that this information should not substitute for a visit or a consultation with a health care provider. The views or opinions expressed in the resources provided do not necessarily reflect those of Thomas Jefferson University, Thomas Jefferson University Hospital, or the Jefferson Health System or staff. Return to Thomas Jefferson University Home Page