While dealing with patients, multiple diagnoses can be made based on people’s health conditions. This situation also refers to Mr. W, who complains of feeling extremely tired and gaining weight. The paper will demonstrate that type 2 diabetes mellitus and coronary artery disease (CAD) can cause these symptoms. The case study analysis will also assess these diagnoses, present their management plans, mention comorbidities, and stipulate medication costs.
Primary Diagnosis Type 2 diabetes mellitus (E11)
pathophysiology, As a rule, two primary conditions contribute to diabetes mellitus. Galicia-Garcia et al. (2020) clarify that it occurs when pancreatic β-cells produce defective insulin and insulin-sensitive tissue fails to respond correctly to it.
pertinent positive findings The diagnosis is typically associated with fatigue, nocturia, and a decreased quality of life (Kabadi, 2017). Kabadi (2017) also admits that dehydration accompanies the symptoms, which makes the patient feel that he cannot get enough to drink.
pertinent negative findings No reported family history of diabetes mellitus of any type. Wu et al. (2018) state that heredity factors are significant predictors of the condition.
the rationale for the diagnosis Increased glucose and hemoglobin A1C levels demonstrate that diabetes mellitus can be under consideration. According to the American Diabetes Association (ADA) (2021), an A1C level of 6.5% or higher indicates diabetes, and the patient’s laboratory result is 6.9%.
Secondary Diagnosis Coronary artery disease (I25.1)
pathophysiology The Centers for Disease Control and Prevention (CDC) (2019) stipulates that a CAD develops because arteries that supply blood to the heart are blocked with plaque. This substance consists of cholesterol deposits that attach to the artery walls and narrow them, preventing or blocking blood flow.
pertinent positive findings These include obesity, increased age, being a man, and disease family history. Hajar (2017) stipulates that these findings are typically associated with a CAD.
pertinent negative findings Normal blood pressure and EKG results and a healthy lifestyle can indicate that a CAD is not suitable (Hajar, 2017).
the rationale for the diagnosis The lipid panel demonstrates that the patient has unhealthy cholesterol levels. Thus, HDL is lower than 60 mg/dl, TC is higher than 200 mg/dl, and LDL is higher than 100 mg/dl, and Shahid et al. (2020) claim that these levels lead to increased CAD risk.
Lab test (#1) 2-hour post load glucose (2-h PG) test during a 75-g oral glucose tolerance test (OGTT) is required to identify whether diabetes is an appropriate diagnosis.
rationale: In relation to diabetes, a 2-h PG test during OGTT is an efficient test to identify the condition (Shahim et al., 2017). A patient should come to a doctor the next morning after a fasting night and drink 75 g glucose dissolved in 200 ml water; a 2-h PG test should be taken in two hours (Shahim et al., 2017).
Lab test (#2) A computed tomography (CT) scan to identify the coronary artery calcium (CAC) score is necessary to check whether the patient has CAD.
rationale: The CAC score demonstrates whether calcium is present in the coronary arteries, which can reveal that they are narrowed because of plaques (Neves et al., 2017). The test can be taken on any day when the patient avoids consuming caffeine for at least four hours.
Medication (#1) – Metformin 1000 mg daily with meals.
Rationale. This medication is the most requested initial treatment of diabetes. This prescription medication inhibits gluconeogenesis in the liver resulting in decreased hepatic glucose production. Yakaryilmaz and Öztürk (2017) justify the use of this drug and admit that its advantages also include low risk of hypoglycemia, positive impact on cardiovascular disease, anti-aging effects, and others.
Medication (#2) – Ibuprofen 1200 mg daily with meals.
Rationale. It is an over-the-counter (OTC) drug to decrease inflammation and relieve pain not associated with diabetes treatment (Taylor, 2017).
Medication (#3) – Rosuvastatin 20 mg daily with or without food.
Rationale. Statins are a widespread prescription medication to treat patients with CAD. Various clinical trials show that this drug reduces cholesterol levels and possesses anti-inflammatory properties that result in atherosclerosis prevention (Diamantis et al., 2017).
Medication (#4) – Aspirin 75 mg daily after meal.
Rationale. This OTC drug is suitable for CAD patients since it is a blood thinner leading to a reduced risk of cardiovascular issues (Yuan et al., 2021).
The patient should understand that he is in a diabetes risk group. The rationale behind this statement is that Mr. W is elderly and obese (Zheng et al., 2018). Thus, the patient should understand that a lifestyle change involving a healthy diet and regular exercise is a significant treatment element (Zheng et al., 2018).
Personalized education regarding a CAD diagnosis also relies on the fact that Mr. W is in a risk group. Obesity and high blood cholesterol levels are widespread causes, meaning that a lifestyle change is required (Hajar, 2017). Furthermore, Hajar (2017) admits that diabetes increases the risk of having CAD.
Metformin is prescribed to lower glucose production in the liver during diabetes (Yakaryilmaz & Öztürk, 2017). However, potential side effects include weight loss and some gastrointestinal issues (Yakaryilmaz & Öztürk, 2017). If these appear, the patient should stop consuming the drug and consult the healthcare provider.
Ibuprofen contributes to a better effect than other antidiabetic agents (Taylor, 2017). This drug implies cardiovascular, gastrointestinal, and renal risks, meaning that it should be taken with caution.
Rosuvastatin is used to cause anti-inflammation effects making arteries more elastic (Diamantis et al., 2017). Ayoub et al. (2020) state that high doses of this drug can result in insulin resistance.
Aspirin is used as a blood thinner to achieve an easier flow of substance through arteries (Yuan et al., 2021). Simultaneously, Yuan et al. (2021) admit that this OTC drug can cause bleeding.
Zheng et al. (2018) stipulate that dietary interventions can be more effective than pharmacological ones in addressing diabetes. A diet should contain high-quality fats, whole grains, fruits, vegetables, and nuts; the Mediterranean diet is associated with a decreased risk (Zheng et al., 2018). This intervention should lead to weight loss, and 135 pounds are the desired target since this weight will indicate that Mr. W has an optimal body mass index of 25 and fewer.
Alvarez-Alvarez et al. (2018) admit that the Mediterranean diet is also beneficial for CAD patients because it provides these people with the necessary nutrients.
Zheng et al. (2018) state that aerobic exercise and resistance training can effectively prevent diabetes. That is why the patient should participate in moderate-intensity resistance training (Zheng et al., 2018).
According to Alvarez-Alvarez et al. (2018), Mr. W can benefit from light-intensity stationary cycling and swimming since these are associated with a decreased CAD risk.
Warning Signs for diagnoses and medications
All the possible warning signs have been discussed since they are symptoms of the stipulated diagnoses and potential side effects of the proposed medications.
Specialty practice or service Cognitive and physical functional assessment.
rationale: The ADA (2021) admits that this referral is suitable for older patients to check whether they can understand treatment recommendations and avoid overtreatment.
Referral(#2) Cardiac rehabilitation
rationale: Giuliano et al. (2017) demonstrate that this referral can improve the patient’s quality of life and reduce cardiovascular mortality.
The patient should return to the primary care physician’s office in three months. The rationale behind this statement is that metformin can produce some results in three months (Sanchez-Rangel & Inzucchi, 2017), while statins can affect bodies in ten weeks (Diamantis et al., 2017).
Assessment of comorbidities
The ADA (2021b) indicates that diabetes leads to an increased risk of dementia because high blood sugar or insulin can negatively affect the brain changing its chemical composition. That is why it is reasonable to refer the patient to a cognitive and physical functional assessment and make him visit a neurologist.
- Metformin 1000 mg 30 tablets – average retail price is $11.17 (GoodRx, n.d.).
- Ibuprofen 200 mg 180 tablets – average retail price is $13.02 (GoodRx, n.d.).
- Rosuvastatin 20 mg 30 tablets – average retail price is $133.5 (GoodRx, n.d.).
- Aspirin 81 mg 30 tablets – average retail price is $3.48 (GoodRx, n.d.).
Thus, the monthly treatment cost for the patient under consideration is $161.17 for both prescribed and OTC medications. This sum does not seem to be a significant financial burden. It does not mean that the drugs were chosen due to their costs; decisions were based on prescriptions’ applicability to the case. However, I will use the medication pricing resources in future practice to check whether a specific drug is affordable for a patient.
The case study analysis identified that Mr. W has two potential diagnoses, including type 2 diabetes mellitus and coronary artery disease. These conditions were reached because the patient has appropriate symptoms and laboratory test results. Thus, the analysis offered detailed commentaries on what treatment plan can be used to manage the conditions, and it was found that the proposed treatment is financially efficient. Finally, potential comorbidity was identified, and it indicates that diabetes can lead to dementia.
Alvarez-Alvarez, I., de Rojas, J. P., Fernandez-Montero, A., Zazpe, I., Ruiz-Canela, M., Hidalgo-Santamaria, M., Bes-Rastrollo, M., & Martinez-Gonzalez, M. A. (2018). Strong inverse associations of Mediterranean diet, physical activity, and their combination with cardiovascular disease: The Seguimiento Unversidad de Navarra (SUN) cohort. European Journal of Preventive Cardiology, 25(11), 1186-1197. Web.
American Diabetes Association. (2021). 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021. Diabetes Care, (Supplement 1), S15-S33. Web.
American Diabetes Association. (2021). 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of medical care in diabetes-2021. Diabetes Care, (Supplement 1), S40-S52. Web.
American Diabetes Association. (2021). 12. Older adults: Standards of medical care in diabetes-2021. Diabetes Care, (Supplement 1), S168-S179. Web.
Ayoub, B. M., Ashoush, N., Tadros, M. M., Zahar, N. M., E., Hendy, M. S., & Mowaka, S. (2020). Rosuvastatin dose should be case individualized: An observation from inherited hypercholesterolemia case study. Phramazie, 75, 531-532. Web.
Centers for Disease Control and Prevention. (2019). Coronary artery disease (CAD). Web.
Diamantis, E., Kyriakos, G., Quiles-Sanchez, L. V., Farmaki, P., & Troupis, T. (2017). The anti-inflammatory effects of statins on coronary artery disease: An updated review of the literature. Current Cardiology Reviews, 13(3), 209-216. Web.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolazza, H., & Martin, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Science, 21(17), 6275. Web.
Giuliano, C., Parmenter, B. J., Baker, M. K., Mitchell, B. L., Williams, A. D., Lyndon, K., Mair, T., Maiorana, A., Smart, N. A., & Levinger, I. (2017). Cardiac rehabilitation for patients with coronary artery disease: A practical guide to enhance patient outcomes through continuity of care. Clinical Medicine Insights: Cardiology, 11. Web.
Hajar, R. (2017). Risk factors for coronary artery disease: Historical perspectives. Heart Views, 18(3), 109-114. Web.
Kabadi, U. M. (2017). Marked weight loss, muscle wasting, and fatigue on administration of empagliflozin in a subject with type 2 diabetes. British Journal of Medicine & Medical Research, 21(5), 1-7. Web.
Sanchez-Rangel & Inzucchi, S. E. (2017). Metformin: Clinical use in type 2 diabetes. Diabetology, 60, 1586-1593. Web.
Shahim, B., De Bacquer, D., De Backer, G., Gyberg, V., Kotseva, K., Mellbin, L., Schnell, O., Tuomilehto, J., Wood, D., & Ryden, L. (2017). The prognostic value of fasting plasma glucose, two-hour postload glucose, and HbA1c in patients with coronary artery disease: A report from Euroaspire IV. Diabetes Care, 40, 1233-1240. Web.
Taylor, J. (2017). Over-the-counter medicines and diabetes care. Canadian Journal of Diabetes, 41(6), 551-557. Web.
Wu, H., Yang, S., Huang, Z., He, J., & Wang, X. (2018). Type 2 diabetes mellitus prediction model based on data mining. Informatics in Medicine Unlocked, 10, 100-107. Web.
Yakaryilmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World Journal of Diabetes, 8(6), 278-285. Web.
Yuan, S., Chen, P., Li, H., Chen, C., Wang, F., & Wang, D. W. (2021). Mortality and pre-hospitalization use of low-dose aspirin in COVID-19 patients with coronary artery disease. Journal of Cellular and Molecular Medicine, 25(2), 1263-1273. Web.
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global etiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14, 88-98. Web.