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Chapter 60: Diabetes
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JR is a 68-year-old African American man with a new diagnosis of T2DM. He was classified as having prediabetes (at risk for developing diabetes) 5 years before the diagnosis and has a strong family history of type 2 diabetes. JR’s blood pressure was 150/92 mm Hg. His laboratory results revealed an A1c of 9.2%, normal cholesterol panel (except glucose of 279 mg/dL), and normal renal/hepatic function were noted with today’s laboratory test results.
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Six weeks later, JR returns to obtain new laboratory test results. He tests his blood glucose and blood pressures at home. Within the last 4 weeks he has started an exercise program four times per week consisting of cardio/resistant training for 40 minutes per session. JR indicates he is motivated to beat this and has reviewed a lot of educational material about diabetes.
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Today’s Laboratory Test Results and Vitals
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Due to elevated home and clinic blood pressure readings it has been decided a second blood pressure medication is needed. Which agent would be the best to start in order to achieve blood pressure control and prevent microvascular complications?
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a. Clonidine 0.1 mg twice daily
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b. Isosorbide mononitrate 60 mg daily
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d. Terazosin 10 mg at bedtime
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Answer c is correct. Lisinopril is an angiotensin-converting enzyme inhibitor and considered to be a drug of choice for renal protection in patients with diabetes. ACEi and ARBs have demonstrated a reduction in renal progression to overt proteinuria. African Americans may not see the maximum effect of blood pressure lowering with ACEi due to a decreased amount of renin.
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Answer a is incorrect. Clonidine does not have supporting data indicating renal protection ...