Skill Checkup: A 65-Year-Old Woman With Treated Type 2 Diabetes Presents With Shortness of Breath and Lightheadedness

Romesh Khardori, MD, PhD


February 23, 2023

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

The patient is a 65-year-old woman in the United States with a 10-year history of type 2 diabetes (T2D). She's been on 1000 mg/day metformin XR since diagnosis. At the last follow-up, she complained of shortness of breath and lightheadedness while going about her usual daily activities, including climbing stairs at home or playing golf; however, these symptoms do not interrupt her activity. She denies symptoms when resting or watching TV, and she has no dyspnea or dizziness while in the office. She was referred for a cardiology workup, which revealed heart failure with reduced ejection fraction (HFrEF). Her body mass index was 26; her blood pressure was 130/85 mm Hg on a beta blocker; left ventricular ejection fraction (LVEF) was 38%; ECG was normal; hemoglobin A1C (HbA1C) = 7.5%; low-density lipoprotein cholesterol (LDL-C) = 110 mg/dL (not on a statin); and estimated glomerular filtration rate = 70 mL/min/1.73 m2.


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