Interactive case study: Cardiovascular disease and type 2 diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.

These three scenarios review the primary and secondary prevention of cardiovascular disease, along with glycaemic management, in people with type 2 diabetes.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.

Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.

Kapil, a 47-year-old male of Asian ethnicity, is admitted to hospital as an emergency, where a diagnosis of myocardial infarction is confirmed. Investigations reveal a random blood glucose level of 12.7 mmol/L and an HbA_1c of 61 mmol/mol (7.7%).

Following recovery and home, Kapil arranges an appointment at his GP practice for review.

What do you need to find out at this appointment?

Julie is a 58-year-old Caucasian lady with type 2 diabetes of 7 years’ duration, as well as hypertension. She sees her GP with episodic central chest discomfort radiating to her neck and left shoulder, together with shortness of breath that is brought on by exercise and relieved by rest.

What is your assessment of Julie’s problem, and what therapeutic interventions might you consider at this stage?

Mark, a 67-year-old man with type 2 diabetes for 11 years, has elevated HbA_1c despite treatment with metformin and a sulfonylurea. His QRISK3 score indicates a 10-year cardiovascular risk of 27%.

What would be your next choice for glycaemic management and for primary cardiovascular prevention?