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Patient Case Study (APL) - Cardiometabolic Risk Reduction in the Metabolic Syndrome and Type 2 Diabetes

Please select a patient from YOUR clinical practice that is most similar to the patient described below. Please reflect on his/her history and course of treatment when providing case-related details and answering case-related questions.

Patient Profile
  • 41-year-old Hispanic male who works in sales
  • Has not seen a physician in 5 years
  • Weight = 236 lb
  • Height = 5’8’’
  • BMI = 35.9 kg/m2
  • Waist circumference = 48 inches
  • Blood pressure = 138/84 mm Hg
  • Fasting plasma glucose = 129 mg/dL
  • TG = 250 mg/dL; TC = 265 mg/dL; LDL-C = 196 mg/dL; HDL-C = 32 mg/dL
  • Has never been prescribed pharmacotherapy for weight loss before
  • History of unsuccessful weight loss attempts over the past year
  • Current medications: None
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1.Would you recommend lifestyle changes to help this patient control his numerous cardiometabolic risk factors (eg, hypertension, dyslipidemia, elevated plasma glucose)?
 
Yes
No

2.Which of the following lifestyle changes would you recommend for this patient? Check all that apply.
 
I would not recommend lifestyle changes for this patient
Low-calorie diet
Low-carbohydrate diet
Low-fat diet
Increase in lifestyle activity
Increase in structured physical activity

3.How likely is this patient to be adherent to therapeutic lifestyle recommendations?
 
Very likely
Moderately likely
Somewhat likely
Moderately unlikely
Very unlikely

4.Would you recommend pharmacotherapy for this patient to improve blood glucose levels?
 
Yes
No

5.If you would treat this patient with pharmacotherapy to improve glucose levels, which of the following agents would you recommend? Check all that apply.
 
Not applicable
Metformin
Sulfonylurea
Thiazolidinedione
DPP-4 inhibitor
Incretin mimetic
Insulin
Other

6.Would you recommend pharmacotherapy for this patient to improve dyslipidemia?
 
Yes
No

7.If you would treat this patient with pharmacotherapy to improve dyslipidemia which of the following agents would you recommend? Check all that apply.
 
Not applicable
Statin
Fibrate
Niacin
Bile acid sequestrant
Selective cholesterol absorption inhibitors
Other
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8.Would you recommend pharmacotherapy for this patient to improve hypertension?
 
Yes
No
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9.If you would treat this patient with pharmacotherapy to improve hypertension which of the following agents would you recommend? Check all that apply.
 
Not applicable
ACE inhibitor
ARB
CCB
Beta Blocker
Diuretic
Renin inhibitor
Other

10.Would you recommend pharmacotherapy for this patient to promote weight loss?
 
Yes
No
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11.If you would recommend pharmacotherapy to promote weight loss in this patient, which of the following FDA approved therapies would you recommend for this patient?
 
Not applicable
Orlistat
Sibutramine
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12.Which of the following factors would influence your treatment decision? Check all that apply.
 
Efficacy
Durability of effect
Potential side effects
Potential beneficial effect of weight-loss pharmacotherapy on comorbid conditions
Potential adverse effect of weight-loss pharmacotherapy on comorbid conditions

13.Which of the following factors would decrease the likelihood that this patient will adhere to treatment with orlistat? Check all that apply.
 
Socially embarrassing side effects
Inadequate efficacy
Undesirable effects on comorbid conditions
Polypharmacy for multiple comorbidities
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14.Which of the following factors would decrease the likelihood that this patient will adhere to treatment with sibutramine? Check all that apply.
 
Socially embarrassing side effects
Inadequate efficacy
Undesirable effects on comorbid conditions
Polypharmacy for multiple comorbidities
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15.Which of the following factors would make weight-loss pharmacotherapy more attractive to you as a clinician? Check all that apply.
 
Improved efficacy over existing therapies
More durable treatment effects
Improvements in comorbid conditions
Better safety profile

16.Which of the following factors would make weight-loss pharmacotherapy more attractive to your patients? Check all that apply.
 
Improved efficacy over existing therapies
More durable treatment effects
Improvements in comorbid conditions
Better safety profile

17.When would you schedule a follow-up visit for this patient?
 
1 month
2 months
3 months
6 months

18.Would you recommend weight-loss surgery for this patient if treatment with pharmacotherapy were ineffective?
 
Yes
No
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19.Which of the following factors would influence your decision to recommend weight-loss surgery? Check all that apply.
 
Efficacy
Lack of efficacy of less invasive options
Durability of effect
Procedural risk
Comorbid conditions
Potential beneficial effect of weight-loss surgery on comorbid conditions
Potential adverse effect of weight-loss surgery on comorbid conditions