From the Guidelines
For a 33-year-old obese prediabetic, hypothyroid female with significantly decreased DHEA-S levels (17.9 μg/dL vs. normal range 98-340 μg/dL), I strongly recommend focusing on intensive lifestyle modifications, including a balanced anti-inflammatory diet, regular exercise, stress management techniques, and adequate sleep, as the primary approach to manage her condition, as supported by the most recent evidence 1. These lifestyle modifications should aim at achieving a weight loss goal of at least 3–7% from baseline body weight to reduce the risk of progression to type 2 diabetes and improve overall health outcomes. Additionally, considering her low DHEA-S levels, DHEA supplementation starting at 25 mg daily, taken in the morning, can be considered, with gradual increases to 50 mg daily if needed after monitoring levels in 3 months. It is crucial to monitor the patient's response to these interventions and adjust the treatment plan as necessary to ensure the best possible outcomes in terms of morbidity, mortality, and quality of life. The patient should also be screened for disordered eating behaviors and provided with individualized nutrition therapy to address any maladaptive eating behaviors, as emphasized in recent guidelines 1. Regular follow-up appointments should be scheduled to assess the patient's progress, adjust the treatment plan as needed, and monitor for any potential side effects of DHEA supplementation, such as acne, hair growth, or mood changes. By prioritizing lifestyle modifications and closely monitoring the patient's response to treatment, we can work towards improving her overall health outcomes and reducing her risk of developing type 2 diabetes and other related comorbidities, as supported by the latest evidence 1.
From the FDA Drug Label
INDICATIONS: Temporarily supports the body to rebalance Adrenal and DHEA output. Symptoms of imbalanced Adrenal and DHEA may include: low energy, depression, anxiety, dry eyes, skin, and hair, loss of head hair. The patient's symptoms and laboratory results, including decreased DHEAs, may be related to an imbalance of Adrenal and DHEA output.
- Key Considerations:
- The patient's low DHEA levels (17.9 vs normal 98-340) may be associated with symptoms such as low energy, depression, and anxiety.
- The patient's obesity, prediabetes, and hypothyroidism should be taken into account when considering treatment options. Given the information provided, DHEA (PO) may be considered to temporarily support the body to rebalance Adrenal and DHEA output 2.
From the Research
Obesity Management
- The patient's obesity is a significant concern, as it increases the risk of multiple chronic diseases and premature mortality 3.
- A comprehensive approach to obesity management, such as the SECURE model, can be useful in evaluating and treating the patient 4.
- Lifestyle interventions, including calorie restriction and increased physical activity, can lead to a mean weight loss of 2% to 9% of initial weight at 1 year 3.
- Adjunctive treatments, such as antiobesity medications and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions 3.
Prediabetes Management
- The patient's prediabetes is a significant concern, as it affects 1 in 3 adults in the US and approximately 720 million individuals worldwide 5.
- Intensive lifestyle modification, consisting of calorie restriction, increased physical activity, self-monitoring, and motivational support, can decrease the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 5.
- Metformin can also decrease the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years 5.
DHEA Levels
- The patient's decreased DHEA levels may be related to her obesity and prediabetes, as DHEA has been reported to have beneficial effects on diabetes mellitus and obesity in animal models 6.
- However, a meta-analysis in elderly men and women found that DHEA supplementation has no effects on blood glucose levels 6.
- Further studies are needed to provide greater insight into the effect of DHEA on diabetes and obesity in animal and human models 6.
Hypothyroidism
- The patient's hypothyroidism may also be related to her obesity and prediabetes, as hypothyroidism can increase the risk of developing type 2 diabetes and obesity.
- However, there is no direct evidence in the provided studies to support this relationship.
Primary Care Management
- Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity and prediabetes 3, 7.
- Practice nurses in primary care can provide effective obesity management and weight loss advice to patients, but may need additional training and support to do so effectively 7.