Eva is a 45 y.0., pre-menopausal woman, who was Dx with NIDDM 6/12. She was prescribed metformin 500mg twice per day and is now returning for a script and ‘assessment of her glycaemic control. She is on no other medications. Her “chulesterul” wus mormal 3 years ogo. What further information will you need? + other vascular risk factors (Non-smoker, no FHx of premature vasc disease, BP=150/85, CVS examination = normal, no evidence of peripheral neuropathy or retinopathy, urinary dipstick is negative for pratein) = obesity/overweight (BMI=31kg/m?, waist/hip ratio=0.95) + further lifestyle impravenents (A dietician advised « low fat, low sugar diet and Eva has lost 4kg in the last 6/12, she does not perform any regular exercise) = how good has the glycaemic control been (uses blood glucose test strips, FBG readings have been b/w 8-10mmol/L, her Hb Alc was 9.3%) What further tests will you do? + plasma creatinine (0.07:nmol/L, N=0.05-0.10) + urinary microatbumin (using an early morting sample) (15mg/L, Ne«20) LDL = 3.8mmol/L (<3.7) Eaveral menthe! later Cra returns te have her Lipid prefile and [1b Ate cesssoesed, which have not changed since you performed the last set of investigations. She has not lost any more weight; FBG's are now b/w 7-10. How would you manage the iipras? = She has been on an appropriate diet for 6/12, s0 is now eligible for subsidised medications, + Gemfibrozil (a fibrate) is the first drug of choice for 2/12, when she needs further assessment. In 2/12 her lipid profile is: Total chol = 5.8 Triglyceride = 1.9 HDL = 1.0 LoL: 3.9 How do you interpret these results? Diabetic dyslipidaemia characterised by reasonably normal LDL, with high triglyceride ‘and low HDL. (Leads to increased vascular risk.) How do you manage Eva now? exclude secondary causes of dyslipidaemia (nephrotic syndrome, hypothyroidism, Beto-blockers, Thiazides) = consider further review of Eve's diet, and institute an exercise program + increase the dose of metformin + repeat the lipid profile after several months of further lifestyle modification