Case Scenario:
Mr. J.R. is a 52-year-old Hispanic male presenting for a routine follow-up. He reports fatigue, increased thirst, and weight gain over the past year.History:
PMH: Type 2 diabetes (6 years), hypertension, dyslipidemia, obesity
Medications: Metformin 1000 mg BID, Lisinopril 10 mg daily, Atorvastatin 20 mg nightly
Social: Sedentary lifestyle, works two jobs, limited access to healthy food
Family history: Father with MI at 59
Vitals:
BP: 148/92 mmHg
BMI: 36 kg/m²
Labs:
A1C: 9.1%
LDL: 142 mg/dL
Triglycerides: 265 mg/dL
eGFR: 68 mL/min/1.73m²
Urine albumin/creatinine ratio: 45 mg/g
Student Assignment Requirements (APA 7)
Students must submit a 6 pages scholarly assignment (excluding title and references) addressing:
1. Pathophysiology (25%)
Explain the interrelationship between insulin resistance, obesity, hypertension, dyslipidemia, and endothelial dysfunction
Describe progression to microvascular and macrovascular complications
Integrate evidence-based literature
2. Comprehensive Assessment (30%)
Focused and comprehensive primary care assessment
Cardiovascular risk stratification (ASCVD)
Identification of red flags and complications
Preventive care and screening needs
3. Pharmacology & Management (35%)
Evidence-based medication optimization per ADA, ACC/AHA, and KDIGO guidelines
Justification for adding/changing medications (e.g., GLP-1 RA, SGLT2 inhibitor)
Non-pharmacologic management
Monitoring and follow-up plan