- What do the findings suggest?
The elevated glucose and the elevated Hgb A1C are indicative of diabetes mellitus. Given that he is overweight, with a BMI of 35.8, he most likely has type II diabetes mellitus.
- What are possible health problems in the future?
Diabetes mellitus predisposes to accelerated, more severe atherosclerosis. Major organs affected are heart, kidneys, and brain. Peripheral vascular disease with ulcerations often occurs. He could develop visual problems.
- What are possible lifestyle modifications to prevent these problems?
In many cases of type II diabetes mellitus, losing weight will improve the situation. This is a difficult undertaking for most middle-aged Americans. Adopting a diet that one can live with on a long-term basis, coupled with a regular program of exercise, is indicated, but difficult for most persons to accept, let alone follow. Nevertheless, it is important for the physician to inform patients of the risks and the solutions.
- What pharmacologic therapies are available?
In type II diabetes mellitus, there is still insulin, so the major drugs used are the sulfonylureas. In cases where hyperglycemia persists, insulin therapy may be considered.
- What is this man's socioeconomic status most likely to be?
Ironically, in developed nations, poor people are more likely to be obese than well-to-do persons. Some people have argued this is the worst-considered social policy when it comes to health in the U.S. Why do we have the highest rates of diabetes and obesity? A good argument can be that it is our eating too much fast food and junk food. All developed nations subsidize agribusinesses, not family farms, to keep commidity costs--and food costs--low. Two examples are sugar and corn (maize). Processed white sugar is cheap in modern society, while it was a luxury item before the 20th century. Feed corn for cattle subsidizes the cost of hamburgers and corn syrup goes into soft drinks.
If the cost of junk food increased 50% in a year, consumption would go down. Instead of satiating our appetites with calorie-dense, high glycemic index snacks, we might try eating something new to our pale palettes: fresh food, food with colors left in it instead of bleached white like our sugar and our bread. (The best way to guess the nutrition of many foods is the color: eat more red stuff, more orange stuff, more green stuff, more blue stuff. The darker the color the better. Snack on cranberries and blueberries. Have a salad with every meal. Avoid WHITE bread and WHITE sugar. You'll start to lose weight, and decrease your risk of cancer to boot.) Ask your poor patients if they like collard greens, or sweet potatoes. The ultimate irony is this: poor people at greatest risk for obesity-related diseases are least able to afford the medical care to treat them.
