Treatment Plan for Sarah’s Type 2 Diabetes

1. Initial Treatment

Based on the latest guidelines (American Diabetes Association – ADA), Sarah’s initial treatment plan will include both pharmacological and non-pharmacological interventions:

Non-pharmacological:

• Lifestyle modifications: This is the cornerstone of T2DM management. Key areas to address include:
  • Diet: Recommend a healthy eating plan focusing on whole grains, fruits, vegetables, and lean protein while limiting processed foods, sugary drinks, and saturated fats.
  • Physical activity: Encourage regular exercise, aiming for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.
  • Weight management: Advise Sarah on healthy weight loss strategies, aiming for a 5-7% reduction in body weight.

Pharmacological:

• Metformin: As per ADA guidelines, metformin is the first-line medication for most patients with T2DM unless contraindicated. It helps improve insulin sensitivity and manage blood sugar levels.

2. Additional Measures for Cardiovascular Risk

Considering Sarah’s lipid profile and blood pressure, addressing cardiovascular risk is crucial:

Non-pharmacological:

• Continued focus on the aforementioned lifestyle modifications plays a vital role in managing cholesterol and blood pressure.

Pharmacological:

• Statins: Based on her total cholesterol level (above 200 mg/dL), Sarah would likely benefit from statin therapy to lower LDL cholesterol.
• Blood pressure medication: Given her blood pressure reading (135/78 mmHg), monitoring is necessary. Depending on future readings, medication initiation might be considered to keep her blood pressure below 130/85 mmHg.

3. Referrals

• Registered Dietitian (RD): A referral to an RD can provide Sarah with personalized dietary guidance and support for developing a sustainable meal plan.
• Certified Diabetes Educator (CDE): A CDE can offer specialized education on diabetes management, including carbohydrate counting, self-monitoring of blood glucose, and medication administration.
• Physical Therapist: A physical therapist can create a safe and effective exercise program tailored to Sarah’s needs and limitations.

4. Follow-Up Appointment

Scheduling a follow-up appointment within 1-2 months is crucial to assess Sarah’s response to treatment. During this visit, the PCP will:

• Review blood sugar levels and HbA1c to evaluate treatment effectiveness.
• Monitor weight changes and progress towards lifestyle goals.
• Address any side effects or challenges Sarah experiences with medications or lifestyle modifications.
• Refine the treatment plan as needed.

Additional Notes:

• Throughout Sarah’s care, the importance of ongoing monitoring and patient education will be emphasized for successful diabetes management and overall health improvement.

Remember, this is a general guideline, and specific treatment decisions may vary depending on Sarah’s individual response and further evaluation by the PCP.