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Vijay, 55

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, sulphonylurea)
  • Dyslipidaemia, 2 years (statin)
  • Hypertension, 2 years (ACEi)
  • Former smoker (pack years: 20), no alcohol consumption
  • Sedentary lifestyle
  • Family history of cardiovascular (CV) disease

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
  • FIB-4 score 0.8 (learn more )
  • eGFR 89 mL/min/1.73 m2
  • uACR 27 mg/g

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

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Clinical data 

This is a fictional case study. The model is not a real patient and the situation shown does not reflect the model's experience.

References
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  2. Loomba R, Adams L A. The 20% rule of NASH progression: the natural history of advanced fibrosis and cirrhosis caused by NASH. Hepatology 2019;70(6):1885-1888
  3. Sterling R K, Lissen E et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43(6):1317-1325
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  10. American Diabetes Association Professional Practice Committee, ElSayed N A et al. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2023. Diabetes Care 2023;46(Suppl 1):S68-S96
  11. American Diabetes Association Professional Practice Committee, Khunti K et al. 6. Glycemic targets: standards of medical care in diabetes-2023. Diabetes Care 2023;46(Suppl 1):S97-S110
  12. Cosentino F, Grant P J et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020;41(2):255-323
  13. Paul S K, Klein K et al. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 2015;14:100
  14. Davies M J, Aroda V R et al. Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2022:doi:10.2337/dci2322-0034
  15. Tofe S, Arguelles I et al. Real-world GLP-1 RA therapy in type 2 diabetes: a long-term effectiveness observational study. Endocrinol Diabetes Metab 2019;2(1):e00051
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  17. Wharton S, Davies M et al. Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice. Postgrad Med 2022;134(1):14-19
  18. Khunti K, Gomes M B et al. Therapeutic inertia in the treatment of hyperglycaemia in patients with type 2 diabetes: a systematic review. Diabetes Obes Metab 2018;20(2):427-437
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  20. Divino V, Boye K S et al. GLP-1 RA treatment and dosing patterns among type 2 diabetes patients in six countries: A retrospective analysis of pharmacy claims data. Diabetes Ther 2019;10(3):1067-1088
  21. Lajthia E, Bucheit J D et al. Combination therapy with once-weekly glucagon like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes: a case series. Pharm Pract (Granada) 2019;17(4):1588