**Case CC:**

- **Patient Statement:** "I am here to find out the results of my blood tests."
- **History of Present Illness (HPI):** A 63-year-old Caucasian female presents to the family practice clinic on October 1, 2021, for a follow-up on her blood results.

**Past Medical History (PMH):**
- Hypertension (HTN)
- Type 2 Diabetes Mellitus (DM)
- Stroke

**Family History (FH):**
- Both parents have DM, HTN, and hyperlipidemia (both are alive).

**Social History (SH):**
- Alcohol: None
- No smoking history
- Physical Activity: Walks 150 minutes per week with resistance exercises twice a week
- Diet: Eats fried foods a couple of times a month

**Allergies:**
- No known drug allergies (NKDA)

**Medications:**
- Metformin 1000 mg twice a day
- ASA 81 mg once a day
- Hydrochlorothiazide 25 mg once a day

**Physical Examination (PE):**
- Blood Pressure: 148/94
- Height: 5’3’’
- Weight: 150 lbs

**Surgical History:** None

**Laboratory Values:**
- Fasting Blood Glucose: 150 mg/dL
- HDL: 43 mg/dL
- LDL: 150 mg/dL
- Triglycerides (TG): 200 mg/dL
- Total Cholesterol: 243 mg/dL
- ALT: 16
- AST: 18
- Urine Albumin Excretion: 35 mcg/mg creatinine (same result for 2 out of 3 in a 3-6 month period)
- Na: 140
- K: 4.0
- Mg: 2.0
- Ca: 9.5
- Albumin: 4.0
- Scr: 1.1 (normal range for female)
- BUN: 12
- HCO3: 20
- HbA1c: 7.9%
- TSH: Within Normal Limits (WNL)
- GFR: 65 ml/min/1.73m²

**Examinations:**
- Last eye exam: 5 years ago
- Last foot exam: 5 years ago

**Vaccinations:**
- Childhood vaccines (received Hepatitis B vaccine)
- Tdap and PCV-13 last year

**Additional Information:**
- The patient does not want an injectable medication.
- The patient does not want to start insulin at this time unless there are no other options available.
- The physician does not want to increase the metformin dose.
- The patient is compliant with taking medication daily.

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**Questions:**

1. What are the American Association of Clinical Endocrinology (AACE) HbA1c, fasting, and 2-hour postprandial blood glucose goals?

2. What is the most appropriate recommendation for this patient, and why was the therapy chosen (also include what should be done with the metformin)?

3. Does this person need any additional vaccines? If yes, what vaccines should they receive?

4. Does the patient need a foot exam? If yes, explain why.

5. Does the patient need an eye exam? If yes, explain why.

6. When should their next HbA1c be obtained, and explain why?

7. List 2 safety and 2 efficacy parameters of the medication that was chosen for the patient’s #1 health care need.

8. List at least 3 adverse effects of metformin.

9. List the microvascular complications of diabetes.

10. List the macrovascular complications of diabetes.