Case Study: Glycemic Control in the Elderly: Risks and Benefits

Abstract

Presentation R.B. is a 67-year-old woman with obesity, hypertension, and coronary artery disease (CAD). Eighteen months ago, she suffered an inferior wall myocardial infarction (MI). Cardiac catheterization revealed an occluded right coronary artery and a 40% stenosis in the proximal left anterior descending artery. The patient was placed on -blocker and aspirin therapy and was provided education regarding lifestyle modification. A lipid panel revealed mild hypertriglyceridemia and a slightly depressed HDL cholesterol level. Blood glucose was not measured. The patient initially did well, denying chest pain, shortness of breath, or any symptoms related to her cardiac condition. Over the past month, R.B. complained of increasing fatigue and episodes of polyuria and polydipsia. A fasting blood glucose level was 168 mg/dl. Physical examination revealed a mildly obese woman with blood pressure of 142/86 mmHg and a pulse of 78. A dilated eye exam revealed mild nonproliferative diabetic retinopathy. Only trace pedal edema bilaterally was found. Additional laboratory examination revealed a hemoglobin A1c (A1C) concentration of 9.4%, blood urea nitrogen 11 mg/dl, creatinine 0.9 mg/dl, and urine microalbumin 1,993 g/dl on a spot urine sample.