From the Guidelines
The patient should prioritize reducing carbohydrate and sugar intake to manage their elevated HgA1C levels, indicating pre-diabetes, as recommended by the 2021 diabetes management guideline 1. The lab results show that the patient's vitamin D, triglycerides, LDL cholesterol, HDL cholesterol, and liver enzymes are all within normal limits. However, there are a few areas of concern.
- The HgA1C is elevated, indicating pre-diabetes, and dietary modifications are recommended, specifically reducing carbohydrate and sugar intake, as suggested by the American Heart Association guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease 1.
- The creatinine level is slightly elevated, suggesting potential kidney function concerns, and the patient should decrease NSAID use and increase water intake to help address this issue, in line with the 2021 KDIGO clinical practice guideline for diabetes management in chronic kidney disease 1.
- Additionally, calcium levels are slightly elevated, possibly due to blood draw technique, and the patient should avoid taking calcium supplements.
- A follow-up lab test has been ordered for six weeks from now to recheck the calcium level, and the patient will need to come in to complete this test.
- The HgA1C will be rechecked in three months to monitor the patient's progress in managing their pre-diabetes.
- The provider has reviewed the patient's medication list to ensure all medications are appropriate given the kidney function, and no medication changes are needed at this time, as recommended by the 2021 KDIGO guideline 1.
- The patient should continue to limit trans fats while increasing healthy saturated fats in their diet, as part of a comprehensive approach to managing their cardiovascular risk factors, in line with the AHA/ACC guidelines 1.
From the Research
Lab Results and Recommendations
- Patient's vitamin D level is within normal limits (WNL).
- Patient's HgA1C is elevated, indicating pre-diabetes, and the patient should decrease carbohydrate and sugar intake in their diet 2, 3.
- Patient's triglycerides, LDL (bad cholesterol), and HDL (good cholesterol) are all WNL.
- Patient should continue to decrease bad trans fat in diet and increase good saturated fat in diet, as saturated fats may influence pathways affecting inflammation, cardiac rhythm, and hemostasis 4.
- Patient's liver enzymes are WNL.
- Patient's creatinine is slightly elevated, and the patient should decrease NSAIDs and drink plenty of water to monitor this level.
- Patient's calcium is slightly elevated, which may be due to lab draw technique, and the patient should ensure they are not taking a calcium supplement.
Follow-up and Medication Review
- A follow-up lab test is ordered to be completed in 6 weeks to monitor the patient's levels.
- The patient's medication list was reviewed to ensure proper kidney function and ability to continue taking the medication, and no changes were made to the medication at this time.
- The patient's nutritional status and risk factors should be assessed, and a nutritional care plan should be developed to maintain and improve the patient's nutritional condition 5, 6.