• 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 last in a series designed to provide case-based examples of common patient scenarios and the associated management strategies.

Mrs. Johnson is a 60-year-old African-American female complaining of intermittent left shoulder and arm pain. Her pain is dull and lasts 5-10 min. It is always associated with exertion and relieved with rest. The pain started 6 months ago and has occurred many times, but it is not increasing in frequency. She has not had pain in the last 1 month.

Past Medical History:

• Diabetes x 15 yrs
• Hypertension x 20 yrs
• Hyperlipidemia
• Osteoarthritis

Medications:

• Hydrochlorothiazide 25 mg daily
• Lisinopril 20 mg daily
• Aspirin 81 mg daily
• Simvastatin 40 mg at bedtime
• Metformin 1000 mg twice daily
• Glyburide 10 mg twice daily

Physical exam:

• BP 130/80, P 85, T 98.6
• Cardiac exam: regular rate and rhythm, soft S4
• Chest: no chest wall tenderness
• Lungs: clear
• Musculoskeletal: No pain elicited with movement of left arm, no tenderness to palpation of left shoulder or arm.

EKG:

• EKG shows sinus rhythm, no T wave inversions, no ST segment abnormalities; LVH by voltage criteria.