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In yesterday's [Weekly Medical Questions] column, we pushed the latest issue of NEJM Knowledge+ Question of the Week
.
[Weekly Medical Questions] Middle-aged patients with poorly controlled diabetes, which further evaluation should be received? Today, we announce the answer
.
Did you see the answer? Of course, answering right is not the goal, mastering the key points and expanding knowledge is the kingly way
.
Answer: Detection of serum creatinine level Learning points: Screening for diabetic nephropathy requires detection of urine albumin and serum creatinine
.
Knowledge Expansion Diabetic nephropathy is typically characterized by a progressive increase in urinary albumin excretion
.
However, the absence of albuminuria does not rule out diabetic nephropathy
.
Serum creatinine, estimated glomerular filtration rate, and urine albumin levels should be measured annually in patients with type 2 diabetes
.
The patient was in a high-risk group for cardiovascular disease because he had type 2 diabetes and several diabetes-specific risk factors, including retinopathy and neuropathy
.
He has received high-dose statin therapy in accordance with the latest cholesterol treatment guidelines, and his LDL cholesterol is well controlled
.
Therefore, measuring C-reactive protein levels did not alter his cardiovascular risk stratification or cholesterol treatment strategy
.
Routine cardiac stress testing is not recommended in asymptomatic patients with type 2 diabetes
.
Diagnosis of neuropathy in type 2 diabetes without EMG
.
Fructosamine is a glycated protein that is occasionally used to assess glycemic control in patients with inaccurate glycated hemoglobin levels, such as anemia, hemoglobinopathies, or inconsistent fingertip blood glucose values
.
In this patient, both glycated hemoglobin and fingertip glucose were within target ranges; therefore, glycated hemoglobin levels accurately reflect long-term glycemic control, and fructosamine testing is not necessary
.
[Weekly Medical Questions] will be continuously updated
.
What would you like to see or learn? Please let us know through comments and look forward to your valuable comments and suggestions
.
Copyright Information This article was translated, written or commissioned by the NEJM Frontiers in Medicine, jointly created by Jiahui Medical Research and Education Group (J-Med) and The New England Journal of Medicine (NEJM)
.
The full text of the Chinese translation and the included figures are exclusively authorized by the NEJM Group
.
If you want to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal responsibility
.
.
[Weekly Medical Questions] Middle-aged patients with poorly controlled diabetes, which further evaluation should be received? Today, we announce the answer
.
Did you see the answer? Of course, answering right is not the goal, mastering the key points and expanding knowledge is the kingly way
.
Answer: Detection of serum creatinine level Learning points: Screening for diabetic nephropathy requires detection of urine albumin and serum creatinine
.
Knowledge Expansion Diabetic nephropathy is typically characterized by a progressive increase in urinary albumin excretion
.
However, the absence of albuminuria does not rule out diabetic nephropathy
.
Serum creatinine, estimated glomerular filtration rate, and urine albumin levels should be measured annually in patients with type 2 diabetes
.
The patient was in a high-risk group for cardiovascular disease because he had type 2 diabetes and several diabetes-specific risk factors, including retinopathy and neuropathy
.
He has received high-dose statin therapy in accordance with the latest cholesterol treatment guidelines, and his LDL cholesterol is well controlled
.
Therefore, measuring C-reactive protein levels did not alter his cardiovascular risk stratification or cholesterol treatment strategy
.
Routine cardiac stress testing is not recommended in asymptomatic patients with type 2 diabetes
.
Diagnosis of neuropathy in type 2 diabetes without EMG
.
Fructosamine is a glycated protein that is occasionally used to assess glycemic control in patients with inaccurate glycated hemoglobin levels, such as anemia, hemoglobinopathies, or inconsistent fingertip blood glucose values
.
In this patient, both glycated hemoglobin and fingertip glucose were within target ranges; therefore, glycated hemoglobin levels accurately reflect long-term glycemic control, and fructosamine testing is not necessary
.
[Weekly Medical Questions] will be continuously updated
.
What would you like to see or learn? Please let us know through comments and look forward to your valuable comments and suggestions
.
Copyright Information This article was translated, written or commissioned by the NEJM Frontiers in Medicine, jointly created by Jiahui Medical Research and Education Group (J-Med) and The New England Journal of Medicine (NEJM)
.
The full text of the Chinese translation and the included figures are exclusively authorized by the NEJM Group
.
If you want to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal responsibility
.
