Wednesday, October 4, 2023
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Professor of Medicine
Director of Hepatology
University of California at San Diego
Director, NAFLD Research Center
San Diego, California, United States
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
This activity is intended for gastroenterologists, diabetologists, and endocrinologists.
The goal of this activity is for learners to be better able to use appropriate NITs to assess patients for liver fibrosis.
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.
Professor of Medicine
Director of Hepatology
University of California at San Diego
Director, NAFLD Research Center
San Diego, California, United States
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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CME Released: 2/28/2023
Valid for credit through: 2/28/2024, 11:59 PM EST
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Carol is a 50-year-old woman who was diagnosed with type 2 diabetes (T2D) 7 years ago. She comes into your endocrinology office for her first visit after recently moving to the area. Her glycated hemoglobin (HbA1c) is 8% on metformin. You note that she has other indicators of metabolic syndrome such as class 2 obesity, low-density lipoprotein (LDL) cholesterol of 130 g/dL, and her blood pressure (BP) is 130/90 mm Hg on ramipril 5 mg. Her alanine transaminase (ALT) is 65 U/L, aspartate aminotransferase (AST) is 45 U/L, and platelet count is 200,000. Carol explains that things have been hard in her personal life. She got divorced 3 years ago, moved twice, and had 3 jobs changes which interrupted her health insurance. She is finally settled into a new home with a good job and wants to get her health back on track.
Carol's medical record and current laboratory results are listed in Table 1.
| History | Findings |
|---|---|
| Medical | T2D × 7 years, HTN × 15 years, dyslipidemia × 10 years, and obesity |
| Current medications | Metformin 1000 mg twice daily, ramipril 5 mg/d, metoprolol 100 mg twice daily, simvastatin 20 mg/d |
| Social/Occupational | Married; smoker × 30 years, recreational drinker; has 2 adult sons. Sedentary lifestyle. High-fat diet, poor intake of fruit, vegetables, and whole grains |
| Physical Exam | Findings |
| Vital signs | BP: 130/90 mm Hg Heart rate: 78 bpm |
| Body measurements | Weight 90 kg, BMI = 35 kg/m2; class 2 obesity |
| Extremities | No edema |
| Neck | No distended neck veins |
| Heart | LVEF = 60% |
| Lungs | No rales |
| Abdomen | Soft, nontender |
| CBC | Results |
| Normal, except platelets 200,000 | |
| Metabolic Panel | Results |
| FPG | 135 mg/dL |
| HbA1c | 8% |
| Lipid panel | LDL: 130 mg/dL; HDL: 35 mg/dL; TG: 170 mg/dL |
| AST | 45 U/L |
| ALT | 65 U/L |
| eGFR | 91 mL/min/1.73 m2 |
| UACR | 9 mg/g |
BMI, body mass index; CBC, complete blood count; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HDL, high-density lipoprotein; HTN, hypertension; LVEF, left ventricular ejection fraction; TG, triglycerides; UACR, urine albumin-to-creatinine ratio.
