Tuesday, March 28, 2023
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.
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.
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability
and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those
credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the
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.
Follow these steps to earn CME/CE credit*:
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it.
Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print
out the tally as well as the certificates from the CME/CE Tracker.
*The credit that you receive is based on your user profile.
CME Released: 2/28/2023
Valid for credit through: 2/28/2024
processing....
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.
 |
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.
