ANSWER
Analysis of Client Cases and Treatment Strategies
Situation of the Client
The assigned client, a middle-aged person with a history of Type 2 diabetes mellitus (T2DM) and hypertension, arrives at the clinic with elevated blood glucose levels and uncontrolled blood pressure (BP). They occasionally complain of headaches, exhaustion, and lightheadedness, which could be signs of inadequate control of their diabetes and hypertension. Their illness has gotten worse even though they are taking their meds as prescribed, which indicates that their treatment plan needs to be reviewed and modified.
Present-day Drugs
The customer is presently taking:
An ACE inhibitor called lisinopril (20 mg per day) is recommended for diabetic patients with hypertension in order to protect their kidneys.
A first-line medication for type 2 diabetes that lowers blood glucose and improves insulin sensitivity is metformin 1,000 mg twice a day.
A statin used to control hyperlipidemia and lower the cardiovascular risks linked to diabetes is simvastatin (20 mg per day).
Recommendations for Clinical Practice Guidelines (CPGs)
Drawing from the 2022 American Heart Association (AHA) recommendations and the 2023 American Diabetes Association (ADA) Standards of Medical Care:
Controlling Hypertension in Diabetes
The American Diabetes Association advises people with diabetes and high cardiovascular risk to have a goal blood pressure of less than 130/80 mmHg.
Medication Adjustments: A combination therapy strategy utilizing a calcium channel blocker (e.g., amlodipine) or a thiazide-like diuretic (e.g., chlorthalidone) is advised if blood pressure cannot be managed with an ACE inhibitor (ADA, 2023; AHA, 2022).
Management of Diabetes
Control of Glycemic To reduce problems, most persons with diabetes should aim for an A1C level of less than 7%.
Modifications to Medication: For improved glucose management and cardiovascular advantages, if metformin alone is not enough, a GLP-1 receptor agonist (like liraglutide) or an SGLT2 inhibitor (like empagliflozin) should be added.
Control of Lipids
If LDL cholesterol targets are not reached, high-risk patients—such as those with diabetes and hypertension—may need to increase their statin therapy to a high-intensity regimen (e.g., atorvastatin 40-80 mg).
Expert Evaluation
The client’s symptoms and lab results show that their diabetes and hypertension are not being adequately managed. The pharmaceutical measures listed below are required:
Treatment of Hypertension
In addition to lisinopril, take 5 mg of amlodipine daily, a calcium channel blocker, to improve blood pressure control.
Consider taking 25 mg of chlorthalidone per day if more diuretic activity is needed, especially if the patient exhibits symptoms of fluid retention.
Treatment for Diabetes
Add 10 mg of empagliflozin per day. This SGLT2 inhibitor is perfect for patients with diabetes and hypertension since it enhances glycemic management and protects the kidneys and heart.
As an alternative, liraglutide (a GLP-1 receptor agonist) at 1.2 mg per day may be utilized for glycemic improvements and weight control.
Control of Lipids
In order to achieve high-intensity lipid-lowering effects and reduced cardiovascular risks, switch from simvastatin to atorvastatin 40 mg daily.
Extra Thoughts and Questions
Additional data and follow-up evaluations are required in order to maximize the client’s treatment:
Lifestyle and Nutrition
What kind of diet and fitness regimen does the customer currently follow? It could be necessary to provide education about a DASH-style, low-sodium diet and moderate exercise.
Compliance
Do complicated dose regimens, side effects, or cost act as obstacles to medication adherence?
Lab Evaluations
To keep an eye on the safety and effectiveness of new drugs, recent A1C levels, lipid profiles, potassium levels, and renal function (eGFR, creatinine) must be examined.
Signs and Consequences
Do any of the existing prescriptions have any negative affects or side effects, such as gastrointestinal distress from metformin or coughing from lisinopril?
Short-Term Follow-Up Strategy Follow-up:
To evaluate blood pressure, blood sugar, and drug tolerability, schedule a follow-up in two to four weeks.
Obtain the most recent test findings, such as the renal function, lipid panel, and A1C.
Extended Observation:
Every three months, check blood pressure and A1C and make any required medication adjustments.
Every year, check for indications of end-organ disease, such as retinopathy or nephropathy.
Patient Instruction:
Stress that in order to attain the best possible health results, lifestyle changes, medication adherence, and routine monitoring are essential.
Citations
Diabetes Association of America, 2023. Diabetes-related medical care standards—2023. Care for Diabetes, 46 (Supplement 1). dc23-SINT https://doi.org/10.2337
Carey, R. M., Aronow, W. S., Whelton, P. K., et al. (2022). AHA/ACC guidelines for people with high blood pressure in 2022. E95–E100 in Circulation, 145. 10.1161/CIR.0000000000000985 https://doi.org
QUESTION
- Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?
- Assess the applicable clinical practice guideline (CPG) for your assigned client linked on the same page in the lesson where the client case is located. What treatment is recommended by the CPG for your client’s situation?
- Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?
- Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?