Patient with all RF and no known disease
Robert is a 48-year-old stock market trader. He has had type 2 diabetes for four years, and he reports that he will worry about his diabetes when he has more time. He was diagnosed when he had to get a physical for life insurance—sorry he went as he was not granted the policy. He finds his job stressful but loves the intensity. He commutes for work from Delaware to New York City every Sunday and returns Friday night. Since he is not home with his family, he eats out often and loves the street food of the Big Apple. He admits that he may have a fourth meal on nights when he has a hard time winding down to go to sleep.
He has some meds but admits that he does not take them all of the time as he loses his edge and needs to be laser-focused at work. He was diagnosed with sleep apnea two years ago when he went on a family vacation. He got the CPAP but wakes up most mornings with it on the floor. He has gained 12 lbs since he took this job.
Past Medical History: T2 diabetes 2015, mixed hyperlipidemia 2015, hypertension 2015, NAFLD 2015, obstructive sleep apnea 2018, DJD knees 2018.
Social History: Stock market trader, commercial insurance. He is married and has one child and has a grandchild on the way. He smokes cigars on weekends, drinks a six-pack of beer each weekend to unwind. No current physical activity, and food is an overused stress reliever.
Exam: BMI 38.5 kg/m2, 5 ft 10 inches, 268 lbs, BP 156/84, P 92, R 18, Pain 0/10
General: Obese, truncal obesity
eGFR = 120 ml/min
HbA1c = 9.8%
Lipids: total cholesterol 266, HDL-C 28, TG 480, LDL-C not calculated. —
Urine albumin/creatinine ratio: 30mg/g