FM is presenting with signs of new onset type two diabetes mellitus (DM). Polydipsia, polyuria, blurred vision, and significant hyperglycemia are all classic and telling signs of type 2 DM. His A1c of 11.4% confirms the diagnosis. Along with that, his BMI of 39.8 places him in the obese category, which increases his risk of cardiovascular complications. Because FM has a history of hypertension and hyperlipidemia, managing his diabetes carefully is essential to prevent further health issues.

For non-pharmacologic treatments, lifestyle changes are the top priority. FM should be referred to a registered dietitian to help him develop a personalized diet or meal plan a that focuses on reducing carbohydrates, saturated fats, and sugary foods. He should also be encouraged to begin regular physical activity. Something as simple as walking 30 minutes most days can help with weight loss and blood sugar control (Evert et al., 2019). Behavioral health support may also be helpful, especially since FM reported feeling lonely and depressed. Emotional eating can impact his progress. So, addressing the mental health aspect is just as important as physical health.

From a pharmacological standpoint, metformin is the best first-line option. It improves insulin sensitivity, has a favorable safety profile, and may assist with modest weight loss (American Diabetes Association [ADA], 2024). Caution should be taken with FM’s use of hydrochlorothiazide, as thiazide diuretics may increase blood glucose levels (Taylor et al., 2021). If metformin alone isn’t enough, a GLP-1 receptor agonist (semaglutide) or SGLT2 inhibitor (Farxiga) could be added due to their cardiovascular and weight benefits.

For additional labs, FM should get a fasting, lipid panel, renal function tests (eGFR, BUN/creatinine), and liver function tests as well. This is especially important and these labs are necessary since new medications may be added. A urine microalbumin test would also be useful to evaluate for early signs of diabetic nephropathy (ADA, 2024).

References

American Diabetes Association. (2024). Standards of care in diabetes—2024. Diabetes Care, 47(Supplement_1), S1–S350. https://doi.org/10.2337/dc24-Sint

Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H., MacLeod, J., … & Dunbar, S. A. (2019). Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care, 42(5), 731–754. https://doi.org/10.2337/dci19-0014

Taylor, E. N., Curhan, G. C., & Forman, J. P. (2021). Thiazide diuretics and the risk of hyperglycemia. Journal of Clinical Hypertension, 23(4), 765–771. https://doi.org/10.1111/jch.14204