Diabetic Case: 61-year-old Man with Weight Gain

00:00 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.

00:57 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.