A 55-Year-Old Man Comes to the Office for a Routine

A 55-year-old man comes to the office for a routine checkup.  The patient was diagnosed with type 2 diabetes mellitus 3 years ago, and treatment was initiated with metformin and lifestyle modification.  Liraglutide was added to his medical regimen a year ago due to inadequate glycemic control.  The patient reports no symptoms other than the occasional "feelings of low blood sugar" when he skips a meal.  Blood glucose readings during those episodes have been 60-70 mg/dL.  He also takes atorvastatin for hyperlipidemia and low-dose aspirin.  The patient smoked a pack of cigarettes daily for 30 years but quit when he was diagnosed with diabetes.  He does not use alcohol or recreational drugs.  Blood pressure is 128/80 mm Hg, pulse is 76/min, and respirations are 14/min.  BMI is 27.5 kg/m².  Physical examination shows normal heart and lung sounds and normal pulses in the extremities.  There are no lower extremity ulcers or calluses, and vibration and sensory function is intact.  Pressure testing with a 10-g monofilament is normal.  Laboratory results are as follows: Urinalysis is negative for protein, glucose, cells, or casts, and ECG shows no abnormalities.  Which of the following is the most appropriate next step in management of this patient?

A) Begin lisinopril
B) Check urine albumin/creatinine ratio
C) Discontinue liraglutide
D) Initiate niacin
E) Perform exercise stress testing

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free