• Understand the common adherence barriers of medication costs and patient fear and knowledge gaps.
• 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 second in a series designed to provide case-based examples of common patient scenarios and the associated management strategies.

Mr. Fernandez is a 51-year-old factory worker. He feels well today, but admits a weakness for sweet tea and eating French fries for lunch. He says that he enjoys his TV shows and spending time with his kids.

Past Medical History:

• Type 2 diabetes mellitus
• Hypertension

Medications:

• Diovan ® HCT (valsartan) 160/12.5 once daily
• Glipizide 2.5 mg once daily

Physical exam:

• BP 162/94
• His exam is otherwise unremarkable

Laboratory results: (obtained 1 week prior)

• A1C 8.6%

You proceed to discuss his diet and lack of physical activity with him. He agrees to use an artificial sweetener in his tea and eat a salad for lunch. He also plans to take his kids for a daily walk in the neighborhood.