Nancy S.
Age 40
Height 5'4"
Weight 200 lbs
HbA1c 9.2%
BP 160/95
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Type 2 Diabetes and Hypertension, BMI 34
Profile and History:
Nancy S., 40, has type 2 diabetes.
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She is currently taking metformin, 1000 mg bid, and glipizide extended-release, 20 mg/day.
- She was recently started on captopril, 50 mg bid, to reduce her blood pressure, and preserve renal function. Her blood pressure is still elevated in spite of treatment.
- Nancy is chef and owner of a French restaurant.
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Diagnosis and Identification:
Nancy comes to your office for regular monitoring of her glucose levels and her blood pressure.
- She is 5'4", weighs 200 lbs and has a BMI of 34.
- Her HbA1C is 9.2%.
- Weight loss and increased exercise may reduce her need for glucose-lowering drugs, and may help reduce her blood pressure.
- XENICAL will help her lose weight beyond diet alone and the XENICAL-specific diets may give her the structure she needs to lose even more weight.
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Counseling:
- Nancy offers a list of problems she has with dieting and exercise. She asserts that she doesn't eat "all that much" but that her job requires that she taste food throughout the day. She also says she can't fit exercise into her already hectic schedule.
- You explain the increased risks to Nancy's health if she does not modify her eating habits and activity levels and lose weight. You remind her that because of her profession, she is more likely to know how to make low-fat recipes that taste great, and that walking a few minutes a day will help to make a difference.
- You tell her that XENICAL will help her lose weight and may help her stick to her diet. You ask her to include one XENICAL 120-mg capsule, up to 3 times a day, with each main meal containing fat.
More on counseling your patient
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Treatment:
- Treatment goals for Nancy include weight loss, improved glycemic control to avoid microangiopathy and to reduce cardiovascular risk.
- A strategy including XENICAL and a 1600-calorie per day diet is appropriate. For now, you will not change her diabetes or blood pressure treatments. Nancy will be asked to monitor her blood pressure and blood sugar at home. She will be asked to call if she experiences hypoglycemia.
- Encouraging Nancy to keep track of
everything that she eats and when she eats ensures greater compliance.
- Finally, she should engage in more recreational walking.
More on treatment and management
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Follow-Up:
Nancy returns to your office in 4 weeks with her food diary. She has lost six pounds. She tells you from keeping her food diary, she now realizes how much she had been eating while at work. The diary also helped her cut back. In addition, weight loss with XENICAL helped her to lower her blood sugar and blood pressure.
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Outcomes:
Population with Abnormal (Untreated) Risk Factors at Randomization
Weight Loss with XENICAL Plus Diet: Improved Fasting Insulin and Blood Pressure
- In a study of patients with type 2 diabetes stabilized on sulfonylureas, 30% of the patients treated with XENICAL achieved at least a 5% or greater reduction in body weight after one year of treatment compared to 13% of the placebo treated patients. The XENICAL plus sulfonylurea treated patients also achieved significant reductions in sulfonylurea usage and dose reduction as well as significant reductions in HbA1c and fasting glucose compared to the placebo plus sulfonylurea treatment group. In addition treatment with XENICAL plus sulfonylurea was associated with significant reductions in total cholesterol, LDL-cholesterol, LDL/HDL ratio and triglycerides compared to placebo plus sulfonylurea treatment group.
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The long-term effects of XENICAL (orlistat) on morbidity and mortality associated with obesity have not been established.
The patient depicted here is fictitious and is intended to illustrate an obesity-related comorbidity for which a treatment regimen including XENICAL plus a reduced-calorie diet is appropriate. Individual results may vary.
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