García-Martín A, Reyes-García R, García-Castro J M, Muñoz-Torres M
Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Sección de Endocrinología, Hospital Comarcal del Noroeste, Murcia, España.
Unidad de Metabolismo Óseo, Servicio de Endocrinología, Hospital Universitario San Cecilio, Granada, España; Unidad de Endocrinología, Hospital General Universitario Rafael Méndez, Murcia, España.
Rev Clin Esp (Barc). 2013 Aug-Sep;213(6):293-7. doi: 10.1016/j.rce.2013.01.014. Epub 2013 Mar 29.
A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m(2)). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated?
一名62岁女性前来咨询有关四年前诊断出的2型糖尿病的治疗评估。她一直在接受二甲双胍850毫克每日两次的治疗，无慢性相关并发症。她患有高血压和血脂异常。正在接受坎地沙坦/氢氯噻嗪32/12.5毫克和阿托伐他汀40毫克的治疗。她体重92千克，身高162厘米（BMI，35.1千克/平方米）。上次分析显示空腹血糖168毫克/分升，糖化血红蛋白7.5%，微量白蛋白尿为阴性。血压和血脂谱在治疗范围内。两年前她左臂发生非创伤性科雷氏骨折，为此她每天服用钙和维生素D补充剂，并每周服用阿仑膦酸钠。总之，这是一名患有2型糖尿病且代谢控制不佳的肥胖女性患者。她还有脆性骨折病史。该患者应如何评估和治疗？
