From the Guidelines
The plan of care for this 65-year-old female patient should focus on addressing her slightly elevated blood pressure, worsening A1C, and persistent hyperlipidemia, with a priority on maximizing cardiovascular benefits and minimizing risks. The patient's current medications and lab results indicate a need for adjustment in her treatment plan.
- Her enalapril dose should be increased from 10mg to 20mg daily to better control her hypertension, as her current readings of 135/74 are above the target of <130/80 for patients with diabetes, as recommended by 1.
- For her diabetes management, metformin should be maintained at 500mg twice daily, but adding a GLP-1 receptor agonist like semaglutide (Ozempic) 0.25mg weekly (titrating up as tolerated) would be beneficial given her rising A1C from 5.9 to 6.2, as suggested by 1.
- Jardiance 25mg daily should be continued as it provides cardiovascular benefits.
- For hyperlipidemia, lovastatin 40mg should be switched to a more potent statin like atorvastatin 20mg daily to address her elevated total cholesterol of 206 and declining HDL, in line with the recommendations from 1 and 1.
- The patient should be encouraged to increase fluid intake to address the slight dehydration indicated by her BUN/Creatinine ratio.
- Her levothyroxine, famotidine, and vitamin D supplementation should be continued at current doses.
- Additionally, lifestyle modifications including a low-sodium, low-carbohydrate diet and regular physical activity should be emphasized, as recommended by 1 and 1.
- A follow-up appointment in 2-3 months with repeat labs is recommended to assess the effectiveness of these interventions.
From the Research
Patient Assessment
- The patient is a 65-year-old female with a medical history of type 2 diabetes, hypertension, and hyperlipidemia.
- She is currently taking multiple medications, including vitamin D, metformin, lovastatin, Jardiance, levothyroxine, enalapril, and famotidine.
- Her blood pressure is slightly elevated at 135/74, and her A1C has increased from 5.9 to 6.2.
- Her cholesterol levels have shown slight improvement but are still elevated at 206, with a decrease in HDL from 81 to 68 and an increase in triglycerides from 136, which is still within normal range.
Plan of Care
- Consider adjusting the patient's medication regimen to better manage her diabetes, hypertension, and hyperlipidemia.
- The use of SGLT2 inhibitors, such as Jardiance, has been shown to have cardiorenal protective effects and can affect the plasma lipid profile 2.
- The combination of metformin and statins, such as lovastatin, has been shown to be effective in reducing cardiovascular risk in patients with type 2 diabetes and dyslipidemia 3, 4.
- The patient's medication regimen should be reviewed and optimized to ensure that she is receiving the most effective treatment for her conditions.
- Lifestyle modifications, such as diet and exercise, should also be encouraged to help manage her conditions.
- Regular monitoring of the patient's blood pressure, A1C, and lipid profiles is necessary to assess the effectiveness of her treatment plan and make any necessary adjustments.
- A medication regimen review, as described in 5, can help identify any potential issues with the patient's current medication regimen and ensure that she is receiving the most effective treatment.
- The combination of statins and ACE inhibitors, such as enalapril, has been shown to increase lifespan in animal models and may have beneficial effects in humans 6.