A Middle-aged Man with Multiple Red Flags: How Would You Proceed?

By Edward Shahady, MD | February 21, 2012

Medical Director, Diabetes Master Clinician Program, Florida Academy of Family Physicians

Jose is 47-year-old Hispanic male who comes to your office for a “check up.” His only symptom is that he notices he does not have the energy he once had but thinks “it’s because of his weight.” He has worked at a desk for 3 years and has gained 12 pounds.

He has several paternal aunts and uncles with Type 2 diabetes and his father died at age 49 from an MI. His BMI is 29, blood pressure, 143/88 mm Hg, and his waist circumference is 42 in.

Lab values:

Fasting blood sugar: 132

HbA1c : 6.2

Total Cholesterol: 180; triglycerides: 250; LDL (calculated): 100; HDL: 30; non-HDL: 150

Do you consider an LDL of 100 and a non-HDL of 150 significant? What is your diagnosis? Would you consider medication in addition to recommending lifestyle changes?

Thank you for submitting your answers and comments. I invite you to read a summary discussion. . . please click here.

by gotam chand | March 04, 2012 10:33 AM EST

life style modification.
repeat FBS in few days.
repeat Hga1c in 3 months.
offer metformin for DM v/s high risk for DM, metabolic syndrome.
life style modification, low fat diet, weight loss, daily exercise. repeat lipid panel in 3 months.
blood work, cbc, cmp, thyroid panel, urine microalbumin.

by Mazhar Zaidi | March 01, 2012 11:15 AM EST

repeat FBG and do Hb A1c and Alb:Creatinie raio, no meds for Lipids at this time, Metf for DM to start with and check renal function at the base line and in 4-6 weeks.

by Mazhar Zaidi | March 01, 2012 11:12 AM EST

Goal for LDL is below 70 and I will reccomend diet and Ex for this

by Ashish Patel | February 29, 2012 10:47 AM EST

He has Metabolic syndrome, and most likely has T2DM. Recheck Fasting Blood Glucose, and if more than 125, then T2DM is sure. Because of age >40yrs in a diabetic, I would start statin to reduced LDL by at least 30%. This can reduce his TGs also. Omega 3 FAs can be tried (in addition to the statin).

by Shibin Sudevan | February 29, 2012 2:46 AM EST

The values are definitely significant in this clinical scenario, but since he had never been subjected to any lifestyle mofdifications(LSM) till date, it is best to start LSM and reassess at 3 months.

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