• List current goals and testing frequency in patients with diabetes mellitus (DM) (A1C, BP, Cholesterol)
• Discuss when (and when not) to intensify medication regimens to achieve control
• Describe a short and practical way to assess adherence

Jeroan J. Allison, MD
Vice Chair and Professor, Department of Quantitative Health Sciences
University of Massachusetts School of Medicine
Worcester, MA

Formerly, Professor, Division of Continuing Medical Education
University of Alabama at Birmingham
Birmingham, AL

Carlos Estrada, MD
Associate Professor,
Division of General Internal Medicine

Monika Safford, MD
Associate Professor,
Division of Preventive Medicine

University of Alabama School of Medicine, UAB
Birmingham, Alabama

The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The boards of nursing in many states, including Alabama, recognize Category 1 continuing medical education courses as acceptable activities for the renewal of license to practice nursing.

Diabetes affects approximately 23.6 million people (7.8% of the population) across the U.S. and is the primary diagnosis in approximately 28.6 million ambulatory care visits each year[1,2] Management of diabetes in the primary care setting is an important, but often challenging, responsibility for many physicians and health care providers. Evidence-based guidelines for diagnosis and management of diabetes have been disseminated by the American Diabetes Association.[3] The current module is the first in a series designed to provide case-based examples of common patient scenarios and the associated management strategies.

Mrs. Hardy, a 62-year-old African American woman, comes to your office for routine follow-up without any complaints. You last saw her 6 months ago. She brings her BP measurements obtained at a local pharmacy. Her BP for the past 3 months has ranged from 140-158 (SBP) and from 85-98 (DPB).

Past Medical History:

• Diabetes mellitus, type II
• Hypertension
• Hyperlipidemia
• Osteoarthritis

Medications:

• Hydrochlorothiazide 25 mg daily
• Enalapril 5 mg daily (Vasotec ®)
• Glyburide 5 mg daily (Diabeta ®, Glynase ®, Micronase ®)
• Simvastatin 5 mg daily (Zocor ®)

Physical exam:

• BP 154/96
• Weight 264 lb (up 4 lb from last visit)
• Height 5'2"
• Her exam is otherwise unremarkable

Laboratory results: (obtained a week prior, in preparation for your visit)

• A1C 7.8%
• Total cholesterol 240 mg/dL
• LDL-cholesterol 142 mg/dL
• Liver function tests normal
• Creatinine normal
• Urine microalbumin negative