Overview
Mr D attended his annual diabetes review in primary care. As part of this routine check, a series of blood and urine investigations were carried out two weeks before the consultation, and the results are now available for discussion.
The review covered all major monitoring domains:
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Renal function and electrolytes: eGFR, creatinine, sodium, potassium, urine ACR
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Diabetes monitoring: HbA1c, fasting plasma glucose, BMI, foot examination, retinal screening
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Lipid profile: total cholesterol, LDL-C, HDL-C, triglycerides
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Cardiovascular risk assessment: QRISK3 score, clinic BP, home BP monitoring, pulse, ECG if required
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Other monitoring tests: liver function (ALT/AST), full blood count, thyroid function where indicated
These investigations provide a comprehensive snapshot of Mr D’s metabolic control and cardiovascular risk.
Initial impressions:
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Some results are reassuring: potassium is normal (safe for spironolactone if required), creatinine is stable, liver enzymes are within monitoring limits, and his foot and eye screenings are up to date.
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However, there are also significant areas of concern: persistently raised blood pressure, HbA1c above target, obesity, LDL-C above goal for high CV risk, microalbuminuria, and a QRISK3 score of 26% indicating high long-term risk.
| Category | Parameter | Result / Value | Comment |
|---|---|---|---|
| Renal Function & Electrolytes | eGFR | 55 mL/min/1.73 m² | Mildly reduced renal function |
| Serum Creatinine | 104 µmol/L | Within normal range | |
| Serum Potassium | 4.3 mmol/L | Safe for spironolactone initiation | |
| Serum Sodium | 138 mmol/L | Normal | |
| Urine ACR | 32 mg/mmol | Indicates microalbuminuria | |
| Diabetes Monitoring | HbA1c | 54 mmol/mol | Suboptimal glycaemic control |
| Fasting Plasma Glucose | 7.8 mmol/L | Above normal range | |
| BMI | 33.1 kg/m² | Obese category | |
| Foot Examination | Completed | No active ulceration | |
| Retinal Screening | Up to date | Reviewed within last 12 months | |
| Lipid Profile | Total Cholesterol | 4.7 mmol/L | Acceptable on statin therapy |
| LDL-C | 2.2 mmol/L | Consider target <1.8 mmol/L in high CV risk | |
| HDL-C | 1.1 mmol/L | Borderline low | |
| Cardiovascular Risk | QRISK3 Score | 26% | High 10-year risk |
| Clinic BP | 162/92 mmHg | Above target | |
| HBPM Average | 158/88 mmHg | Confirms uncontrolled BP |