Guest guest Posted December 11, 2008 Report Share Posted December 11, 2008 Answer and Critique (Correct Answer = This Week’s Question #446 - Diabetes In Control.com Newsletter A 48-year-old woman who has had type 2 diabetes for 6 years is seen for her semiannual examination. She has long-term rheumatoid arthritis treated successfully with low-dosage prednisone (2.5 mg daily). Her blood glucose is well controlled with rosiglitazone and metformin. She asks about effective weight-loss strategies; her body mass index is 32. She consulted a dietitian and lost 1.8 kg (4 lb) in the past 2 months; however, her hemoglobin A1C value slowly increased and is now 7.2%, which she finds “frustrating.†She would like to lose more weight quickly. Which of the following changes, if any, should be made to this patient's diabetes management plan to stabilize and then reduce the hemoglobin A1C value and to facilitate weight loss? A. Make no additional changes to the management plan B. Initiate a resistance-training exercise plan C. Increase the rosiglitazone dosage D. Add a secretagogue -------------------------------------------------------------------------------- Key Point Painful neuropathy in patients with diabetes is treated with a stepwise approach that includes use of antidepressants. Resistance or strength training can improve glycemic control and reduce the requirement for diabetes medications; this approach has little risk and increased benefit for patients with type 2 diabetes who have injury or are at risk for injury because of age, arthritis, obesity, or other physical conditions. Resistance training or strength training can improve glycemic control and reduce the requirement for diabetes medications. This exercise method is safe and effective and can be performed at home with a phone book, soup cans, or liter bottles of water. Conditioning muscles in the legs, arms, and abdomen benefit from lifting and repetitive motion performed in a graduated fashion. Muscle-strengthening exercise benefits young and elderly patients and can be implemented in patients at risk for injuries, including rheumatoid arthritis. Many resources provide information about resistance training, including books, local gyms, and community fitness programs. This patient's initial weight loss while working with a dietitian was significant, which indicates that she understood the concepts taught. She is now asking for a new strategy, which indicates a readiness to change. Making no change to her management plan will not help her lose weight more quickly. Increasing the dosage of rosiglitazone will likely result in weight gain caused by fluid retention, which has been noted to be approximately 2 kg (4.4 lb) in most people taking this drug. Adding a secretagogue may put this patient at risk for hypoglycemia. Bibliography list of 5 items 1. American Diabetes Association. Position statement: standards of medical care in diabetesâ€â€2006 [erratum in Diabetes Care 2006;29:1192]. Diabetes Care. 2006;29:S4-42. [PMID: 16373931] [ PubMed] 2. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286:1218-27. [PMID: 11559268] [ PubMed] 3. Castaneda C, Layne JE, Munoz-Orians L, Gordon PL, Walsmith J, Foldvari M, et al. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care. 2002;25:2335-41. [PMID: 12453982] [ PubMed] 4. Joslin Diabetes Center & Joslin Clinic. Clinical guidelines for pharmacological management of type 2 diabetes: 9/7/06. Available at: www.joslin.org/Files/Pharm_ClinGuide9706final.pdf .. Accessed 3 October 2006. 5. Neporent L, Schlosberg S, Archer SJ. Weight Training for Dummies. 3rd edition Hoboken, NJ: Wiley & Sons, Inc., 1996. list end Please send your comments to publisher@... Need a review of your diabetes knowledge? Check out all of our questions at http://www.diabetesincontrol.com/tyk/index.php Diabetes In Control Free Newsletter for Medical Professionals Quote Link to comment Share on other sites More sharing options...
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