Wednesday, October 4, 2023
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Scientific Director
Arbor Research Collaborative for Health
Ann Arbor, Michigan
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Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
This activity is intended for primary care physicians (PCPs); nephrologists, diabetologists, and endocrinologists; and cardiologists.
The goal of this activity is for learners to be better able to acknowledge serious health risks associated with chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and the availability of novel treatment options shown to reduce the risk of associated complications.
Upon completion of this activity, participants will:
Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.
Disclosures for additional planners can be found here.
Scientific Director
Arbor Research Collaborative for Health
Ann Arbor, Michigan
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
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CME Released: 2/24/2023
Valid for credit through: 2/24/2024, 11:59 PM EST
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Mira is a 63-year-old woman of Asian descent with type 2 diabetes (T2D) diagnosed 12 years ago. She comes into her primary care physician (PCP) for her yearly visit. Her glycated hemoglobin (HbA1c) is 7.4% while taking the maximum dose of metformin and glyburide. She also has osteoarthritis and controlled hypertension on angiotensin receptor blocker (ARB) therapy.
You note that her estimated glomerular filtration rate is (eGFR) is 35 mL/min/1.73 m2 and her serum potassium level is 4.1 mmol/L. Mira's medical history and results of her physical exam and laboratory tests are shown in Table 1.
| History | Findings |
|---|---|
| Medical | T2D × 12 years, osteoarthritis, hypertension |
| Current medications | Metformin 1000 mg/d, glyburide 20 mg/d, losartan 100 mg/d, atorvastatin 10 mg/d |
| Social/occupational | Married, lives with husband and dog; non-drinker; has 2 adult daughters in college |
| Physical exam | Findings |
| Vital signs | BP: 120/80 mm Hg Heart rate: 78 bpm |
| Body measurements | BMI: 25.5 kg/m2 |
| Extremities | No edema |
| Neck | No distended neck veins |
| Heart | Echo: presence of LVH, LVEF: 60%, BNP: 90 pg/mL |
| Lungs | No rales |
| Abdomen | Soft, nontender |
| CBC | Results |
| Normal | |
| Metabolic panel | Results |
| HbA1c | 7.4% |
| Lipid panel | LDL: 65 mg/Dl; HDL: 41 mg/Dl, TG: 145 mg/Dl |
| SrCr | 1.55 mg/Dl |
| eGFR | 35 mL/min/1.73 m2 |
| Serum potassium | 4.1 mmol/L |
BMI, body mass index; BP, blood pressure; bpm, beats per minute; BNP, brain natriuretic peptide; CBC, complete blood count; Echo, echocardiogram; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; SrCr, serum creatinine; TG, triglyceride.
