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Primary Care Action Interactive Cases
Complete these interactive, fictional case study modules to enhance your knowledge on managing type 2 diabetes (T2D), obesity and non-alcoholic steatohepatitis.
Clinic patient list7
David
Check-up appointment
Theme: identifying emerging comorbidities in people with T2D
Case previewYou have completed 0 module(s).
Completing four modules will allow you to download a certificate for your learning records. Please ensure you use the same device for continuity.
Case preview
Jakub is a 56-year-old male who works as a transport manager. He is visiting you to review his health screen results.
Patient history
- Recently visited the clinic to get vaccinations prior to his daughter and newborn grandchild moving in with him
- Was encouraged by primary care physician to undergo a health screen
- Jakub has returned to the clinic to talk through the results
Current clinical measurements
- BMI 34 kg/m2 (8 months prior: BMI 32 kg/m2)
- HbA1c 5.8% (40 mmol/mol)
- BP 118/78 mmHg
- Total cholesterol 3.9 mmol/L (151 mg/dL)
- Non-smoker and moderate alcohol consumption
- LDL cholesterol 2.0 mmol/L (77 mg/dL)
- ALT 21 U/L and AST 14 U/L
- Additional information:
- FIB-4 score 1.0 (learn more )
- eGFR 98 mL/min/1.73 m2
Main considerations: this module will focus on initiating weight management discussion with a person living with obesity
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; LDL: low-density lipoprotein; UTI: urinary tract infection
Invite the patient in for consultationCase preview
Vijay is a 55-year-old male who works in an office environment. He is visiting you for a regular check-up appointment.
Patient history and current medications
- Type 2 diabetes (T2D), 4 years (metformin)
- Dyslipidaemia, 2 years (statin)
- Hypertension, 2 years (ACEi)
- Former smoker (pack years: 20), no alcohol consumption
- Sedentary lifestyle
- Family history of cardiovascular (CV) disease: father died from myocardial infarction at age 60
Current clinical measurements
- BMI 30 kg/m2 (12 months prior: BMI 31 kg/m2)
- HbA1c 8.5% (69 mmol/mol)
- BP 121/75 mmHg
- Total cholesterol 4.1 mmol/L (159 mg/dL)
- LDL cholesterol 1.5 mmol/L (58 mg/dL)
- ALT 24 U/L and AST 25 U/L
- Additional information:
- FIB-4 score 0.8 (learn more )
- eGFR 89 mL/min/1.73 m2
- uACR 27 mg/g
Main considerations: this module will cover glycaemic control and CV risk in people with T2D, touching on multifactorial management and treatment escalation
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ACEi: angiotensin-converting enzyme; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; LDL: low-density lipoprotein; uACR: urinary albumin-to-creatinine ratio
Invite the patient in for consultationCase preview
Sofia is a 70-year-old female who is retired and previously worked as a teaching assistant. She is visiting you for a regular type 2 diabetes (T2D) check-up.
Patient history
- T2D diagnosis 12 years ago
- Metformin (12 years), SGLT-2i (4 years), GLP-1 RA (2 years): all at optimum/ maximally tolerated dose
- Non-smoker, minimal alcohol intake
- Hypertension, 10 years (CCB, 8 years)
- Dyslipidaemia, 8 years (statin, 8 years; ezetimibe, 2 years)
- HbA1c target: <7.5% (59 mmol/mol)
- Over the last year has refused recommended treatment intensification with basal insulin
Current clinical measurements
- BMI 32 kg/m2 (4 months prior: BMI 32 kg/m2)
- HbA1c 8.5% (69 mmol/mol)
- BP 128/79 mmHg
- LDL cholesterol 1.4 mmol/L (54 mg/dL)
- ALT 28 U/L and AST 25 U/L
- Additional information:
- Additional information:
- FIB-4 score 1.1 (learn more )
- Additional information:
- eGFR 75 mL/min/1.73 m2
To learn more about starting conversations, diagnosing and managing individuals who are overweight or living with obesity please review additional patient cases on the homepage once you have completed this module.
Main considerations: this module will focus on treatment intensification in people with T2D, focusing on therapeutic inertia and the role of insulin in the treatment pathway
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; CCB: calcium channel blocker; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; LDL: low-density lipoprotein; SGLT-2i: sodium-glucose cotransporter-2 inhibitor; T2D: type 2 diabetes
Invite the patient in for consultationCase preview
Marianna is a 49-year-old female shift worker who works as a nurse. She visits you to discuss her weight.
Patient history
- Lifetime weight issues
- Previous weight-loss attempts have been varied; some have worked temporarily
- Non-smoker
- Moderate alcohol intake
- Struggles to maintain an exercise schedule
- Worried about her weight and its impact on her health and ability to function
- Aware of possible management options
Current clinical measurements
- Current day BMI 32 kg/m2 (BMI 6 months prior: 31 kg/m2)
- HbA1c 5.4% (35 mmol/mol)
- BP 112/78 mmHg
- Total cholesterol 4.0 mmol/L (155 mg/dL)
- LDL cholesterol 2.3 mmol/L (89 mg/dL)
- ALT 12 U/L and AST 21 U/L
- Additional information:
- FIB-4 score 1.0 (learn more )
- eGFR 91 mL/min/1.73 m2
Main considerations: this module will focus on the physical examination relevant to obesity assessment and how this may influence treatment recommendations. Details about the communication skills for opening up discussions about weight are covered in Jakub's case
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; LDL: low-density lipoprotein
Invite the patient in for consultationCase preview
Elara is a 63-year-old female who works as a part-time care assistant. She visits you for a medication review.
Patient history and current medications
- Type 2 diabetes (T2D) diagnosis 10 years ago
- Metformin (10 years), SGLT-2i (3 years)
- Dyslipidaemia (statin, 5 years; ezetimibe, 3 years)
- Non-smoker and minimal alcohol intake
- Recently diagnosed with early-stage CKD and hypertension and prescribed an angiotensin receptor blocker
Current clinical measurements
- BMI 31 kg/m2 (9 months prior: BMI 29 kg/m2)
- HbA1c 8.4% (68 mmol/mol)
- BP 132/78 mmHg
- Total cholesterol 3.6 mmol/L (139.2 mg/dL)
- LDL cholesterol 1.7 mmol/L (66 mg/dL)
- ALT 20 U/L and AST 26 U/L
- Additional information:
- FIB-4 score 0.8 (learn more )
- eGFR 51 mL/min/1.73 m2*
- UACR 29 mg/g
- Creatinine 1.2 mg/dL
Main considerations: this module will explore how renal assessment and therapeutic options interlink with T2D and management approaches
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
*Estimated using the 2021 CKD-EPI creatinine equation.
ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; CKD: chronic kidney disease; CKD-EPI: CKD Epidemiology Collaboration; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; LDL: low-density lipoprotein; SGLT-2i: sodium-glucose cotransporter-2; T2D: type 2 diabetes; UACR: urine albumin-creatinine ratio
Invite the patient in for consultationCase preview
Anthony is a 52-year-old male who works as a taxi driver. He is visiting you for his regularly scheduled type 2 diabetes (T2D) check-up.
Patient history and current medications
- T2D diagnosis 15 years ago
- Metformin (15 years), SGLT-2i (4 years), GLP-1 RA (2 years): all at optimum/ maximally tolerated dose
- Non-smoker, moderate alcohol intake
- Hypertension (CCB, 8 years)
- Dyslipidaemia (statin, 8 years; ezetimibe, 2 years)
- HbA1c target: <7.0% (53 mmol/mol)
Current clinical measurements
- BMI 28 kg/m2 (12 months prior: BMI 29 kg/m2)
- HbA1c 8.1% (65 mmol/mol)
- BP 115/80 mmHg
- LDL cholesterol 1.7 mmol/L (66 mg/dL)
- ALT 21 U/L and AST 18 U/L
- Additional information:
- FIB-4 score 0.7 (learn more )
- eGFR 81 mL/min/1.73 m2
Main considerations: this module will discuss initiating basal insulin treatment, including common side effects, administration and monitoring
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; CCB: calcium channel blocker; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; GLP-1 RA: glucagon-like peptide-1 receptor agonist; LDL: low-density lipoprotein; SGLT-2i: sodium-glucose cotransporter-2 inhibitor
Invite the patient in for consultationCase preview
David is a 59-year-old male who works as a security guard. He visits you for a regular check-up appointment.
Patient history and current medications
- Type 2 diabetes (T2D) diagnosis 7 years ago
- Metformin (7 years), sulphonylurea (5 years), SGLT-2i (2 years)
- Dyslipidaemia, 3 years (statin)
- Hypertension, 3 years (ACE inhibitor)
- Non-smoker and minimal alcohol intake
- Previous assessment:
- HbA1c 6.8% (51 mmol/mol)
- BP 121/79 mmHg
- LDL cholesterol 1.4 mmol/L
- ALT 45 U/L and AST 35 U/L
- BMI 29 kg/m2
Current clinical measurements
- BMI 30 kg/m2
- HbA1c 6.9% (52 mmol/mol)
- BP 125/77 mmHg
- Total cholesterol 3.7 mmol/L
- LDL cholesterol 1.5 mmol/L (58 mg/dL)
- ALT 47 U/L and AST 69 U/L
- Additional information:
- FIB-4 score 2.9 (learn more )
- eGFR 84 mL/min/1.73 m2
Main considerations: this module will focus on identifying emerging comorbidities in people with T2D, including NAFLD and NASH
This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.
ACE: angiotensin-converting enzyme; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BMI: body mass index; BP: blood pressure; eGFR: estimated glomerular filtration rate; FIB-4: Fibrosis-4 index; LDL: low-density lipoprotein; SGLT-2i: sodium-glucose cotransporter-2 inhibitor
Invite the patient in for consultation
Want more? Register your interest for PRACTICE meeting
If you enjoyed these case studies, please join us at a face-to-face educational meeting on the evening of 9th June 2023. There will be small group discussions with your peers and experts in the field to consider the issues raised in these case studies and how they impact your primary care practice.
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