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Type 2 Diabetes Patient Case Simulation

Case Simulation 1

**CLINIC-Sim:** Simulating a Patient-Centered Approach to Optimize Early Glycemic and Weight Control in Type 2 Diabetes

Learn more about glycemic control and weight management in type 2 diabetes

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View Program Overview

Shared Decision-Making Resources

Watch an expert video on shared decision-making and download the conversation starter to aid in your patient interactions

Related Resources

These videos were commissioned by Lilly and are intended to be used by HCPs who treat diabetes for medical, scientific and educational purposes.

Video content is not approved for continuing education credit.

Disclosures: Dr. Matt Capehorn

Unpaid:

Board member of the Association for the Study of Obesity (ASO)
Faculty member of the Primary care Academy of Diabetes Specialists (PCADS)
Expert Advisor to NICE
Professional Advisor to the Obesity Empowerment Network (OEN)

Paid:

Director – RIO Weight management Limited
Medical Director – Lighterlife (commercial VLCD company)
Ad-hoc Medical Advisor – McDonalds UK

Advisory Boards: Lilly, Boehringer Ingelheim, Novo Nordisk; Speaker fees/travel: Lilly, Boehringer Ingelheim, Novo Nordisk; Research income (RIO): Lilly, Boehringer Ingelheim, Novo Nordisk

Patient Information

47-year-old African American female
Diagnosed with T2D 9 months ago
HbA_1c since diagnosis: 8.7%
Current treatment: 1000 mg metformin daily at diagnosis
Followed by registered dietitian/nurse educator

Prediabetes for 2 years preceding diagnosis, tried to manage with diet and exercise
Gestational diabetes with her second child
Hypertension
Obesity
Mixed dyslipidemia

T2D in father, maternal aunt
CAD in father
Hypertension in mother and father

Married, has 2 children ages 10 and 15
Never smoked or vaped, no illicit substances, rarely drinks alcohol
High school math teacher

Normal eGFR, normal urine microalbumin
BMI: 33 kg/m² (195 lbs)
Blood pressure: 145/90 mmHg
Total cholesterol: 210 mg/dL
LDL cholesterol: 109 mg/dL
HDL cholesterol: 44 mg/dL
Triglycerides: 290 mg/dL

Follow-up notes

9 months since diagnosis

The patient was diagnosed with type 2 diabetes, and her HbA_1c was 8.7% at the time. She was started on 1000 mg metformin daily. During that visit, she was advised on lifestyle modifications, including dietary changes to help both her diabetes and hypertension management, as well as recommendations to incorporate exercise. She was encouraged to start a statin for dyslipidemia but was too overwhelmed by her diabetes and declined statin therapy.

At visit 2, her HbA_1c decreased to 7.9%. She again declined a statin and agreed to start an ACE inhibitor. Her metformin was titrated to 1500 mg total daily dose.

13 months since diagnosis (4-month follow-up)

She returns 4 months later.
She is taking a dose of 1500 mg metformin daily (500 mg in the morning and 1000 mg in the evening) without missing doses. She was not able to tolerate a dose of 1000 mg twice daily. Her HbA_1c has decreased to 7.7% from 7.9%, and her body weight remained stable.

BMI: 33 kg/m² (195 lbs)
Blood pressure: 130/85 mmHg
Total cholesterol: 205 mg/dL
LDL cholesterol: 110 mg/dL
HDL cholesterol: 43 mg/dL
Triglycerides: 260 mg/dL

She increased her physical activity by parking farther and trying to walk more, but often struggles to find the time to get more exercise in.
She tries to eat more balanced meals with protein, vegetables and fewer carbohydrates; she finds it difficult to make multiple meals for her family members who prefer to keep to their old dietary routine.
She is motivated to continue working on lifestyle changes and has agreed to start a statin.

Step 1 of 3

Question #1

In addition to continuing metformin 1500 mg daily, which of the following may be the next best step?

Option A:

Continue lifestyle modifications – she is very motivated and prefers not to start another medication

Option B:

Start a sulfonylurea and continue lifestyle modifications

Option C:

Start an incretin receptor agonist and continue lifestyle modifications

Option D:

Start a DPP-4 inhibitor

Related Resources

Shared Decision-Making Video

Hear from Dr. Capehorn on collaborating with patients to individualize care.

VV-MED-145674

Patient-Physician Conversation Starter (PDF)

Tips and tricks to initiate patient centric conversations.

VV-MED-145677

Shared Decision-Making (PDF)

Support early glycemic control and weight management through shared decision-making.

VV-MED-148828

VV-MED-144376

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CLINIC-Sim: Simulating a Patient-Centered Approach to Optimize Early Glycemic and Weight Control in Type 2 Diabetes

Learn more about glycemic control and weight management in type 2 diabetes

Shared Decision-Making Resources

Watch an expert video on shared decision-making and download the conversation starter to aid in your patient interactions

Patient Information

Expand accordion Patient Profile

Expand accordion Medical History

Expand accordion Family History

Expand accordion Social History

Expand accordion Physical Exam and Labs

Question #1

In addition to continuing metformin 1500 mg daily, which of the following may be the next best step?

Related Resources

Patient-Physician Conversation Starter (PDF)

Shared Decision-Making (PDF)

Please rate your satisfaction with the content on the following statements:

Please rate your satisfaction with the content on the following statements:

**CLINIC-Sim:** Simulating a Patient-Centered Approach to Optimize Early Glycemic and Weight Control in Type 2 Diabetes