Skill Checkup: A 36-Year-Old Man With Type 2 Diabetes Is Struggling to Lose Weight

Anne L. Peters, MD; Romesh Khardori, MD, PhD


February 23, 2023

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 36-year-old man in the United States presents for his 3-month follow-up for type 2 diabetes. He has a history of obesity (his height is 5 ft 11 in [1.80 m], weight is 230 lb [104.32 kg], and body mass index is 34.2). He has struggled with his weight since childhood and understands the deleterious effects on his diabetes control but says that he "just can't get the weight off." His endocrinologist suggested bariatric surgery, but the patient rejects that option.

He is taking metformin 2550 mg per day. Current A1c is 9.0 and fasting plasma glucose is 160 mg/dL. He admits to being negligent with self-monitoring. Remarkably, blood pressure and lipid values are within normal limits. Other than obesity, he has no risk factors for cardiovascular disease but does have a family history of myocardial infarction. His brother and both parents are of normal weight.


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