Diagnostic challenge

Dr. H. is a very well-respected 60-year-old oncologist who’s been your patient for the past six years. Other than hyperactive airways disease as a child and mitral valve prolapse (diagnosed by the patient himself while still a medical student), he’s been very healthy. He smoked cigarettes, as most people including physicians did back in the ’70s, but only for a relatively short period of time. Self-monitoring of blood glucose (SMBG), a vital self-management tool in type 1 diabetes, has become a widespread practice in the management of patients with type 2 diabetes not using insulin, yet its use for this indication has not been supported by evidence. Every day, family physicians (FPs) work with obese patients in order to prevent and treat the consequences of obesity mainly through counselling on improving diets and engaging in regular exercise. Usually, the most important difficulty they encounter is in making obese patients move. Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) in several countries and the most common reason for the initiation of renal replacement therapy (RRT)/dialysis.1,3 DN is characterized by persistent albuminuria (> 300 mg/d or 200 µg/min), a gradual decline in renal function/glomerular filtration rate (GFR), and hypertension.