Moving on to another case now, we have a 61-year-old man who comes to see you at the insistence
of his wife. He has gained about 17 pounds over the past 2 years and is increasingly sedentary. His
family history is positive for high blood pressure and for type 2 diabetes and on exam he is
significantly overweight with a BMI of 30 kg/m2, his blood pressure is 140/90 and his heart rate is
80 beats/minute. His hemoglobin A1c is 6.1. What is the best next step in this patient's treatment?
For what we can see based on this patient's history, he is sedentary, he doesn't get much exercise,
and he has also experienced significant weight gain recently. His family history is also positive
for diabetes and hypertension. He is obese based on his BMI, which is a level greater than 30 kg/m2.
His elevated hemoglobin A1c is 6.1% and is in the range of prediabetes. The diagnosis of prediabetes
is thus confirmed and the next step would be to initiate an intensive lifestyle modification for
this patient. Lifestyle modifications include things like exercise programs and dietary restrictions
particularly for carbohydrates and possibly also adding an oral hypoglycemic agent like metformin
if there is no improvement.