Clinical Therapeutics for a Patient with Diabetes Type 2, CKD, COPD, Gout, Mild OA, and HT

CLINICAL THERAPEUTICS
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Introduction & overall health evaluation
Mr DM has been diagnosed with Diabetes Type 2 (DM2), CKD (Chronic Kidney Damage),
COPD (chronic obstructive pulmonary disease). Gout, Mild OA (Osteoarthritis) and HT (total
hyperopia). As the nature of DM2 is, if it not managed early, it may leads to other complications
such as blindness and skin insensitivity. With Chronic Kidney Damage, the patient can only hope
for the recently discovered therapeutic strategies to manage the disease that has already affected
the kidneys.4
Due to historical evidence of smoking, COPD may have been one of the side effects. Presence of
gout will make the case of this patient clinically complex due to age factor, drug-drug
interactions, co-morbidities and refractory tophaceous disease. Although Osteoarthritis is
manageable, it is likely to have notable health effects on Mr. DM’s health in the future. In
addition, total hyperopia could have come as a result diabetes mellitus type two complications.
Total hyperopia will make it harder for Mr. DM to get about with his daily activities including
getting to his regular clinical checkups.
According to data from Australian Heart Foundation, Mr. DM is at an extremely high risk of
getting into an irrecoverable condition. With all these complications, Mr. DM’s life is all at risk,
with minimal chances of survival.
Identification & discussion of standard guideline recommendations
As one of the most basic pharmacologic therapy for type 2 Diabetes (DM2), change of lifestyle
should be the first option for Mr. DM. Additionally, addition of metformin treatment would be
preferable as initial pharmacological therapy if he can tolerate it. However due to his condition
of CKD, the patient may only be recommended with serum creatinine levels of not more than or
equal to 1.5 mg/dL daily.12
COPD is a preventable and treatable disease that that leads to a progressive lung malfunctioning.
To prevent occurrence of exacerbations, there should be effective management of COPD in order
to improve the general quality of life of the patient, and to improve the functionality of the lungs.
This would be aimed at reducing the risk of mortality. However, oxygen therapy would also
reduce mortality in a great way. With COPD, it is a preventable and treatable disease, and MR
DM just needs to be encouraged to be positive minded especially in carrying out the necessary

therapies. According to therapeutic guidelines, interventions are advocated according to the
severity of COPD. In the case of Mr. DM, long-acting bronchodilator therapy should be initiated.
The major risk factor for CKD here would include cardiovascular diseases and hypertension.7
Other factors risk would include old age, family history, and Native American or African
American ethnicity. According to therapeutic guideline, cardiovascular disease and hypertension
cases would be more effective with patients with more than 1-3 % CKD as compared to patients
with a 5% CKD.6 For this particular case, cardiovascular disease prevalence is likely to increase
up to 36% in the case of occurence of CKD. In the event that if first-line agents fail, prednisone
or prednisolone administered at a low dosage of <10 mg daily may be recommended as a second-
line option.
According to the Canadian Society of Nephrology, the estimated glomerular filtrations for CKD
could be at the rate of < 60 mL/min/1.73 m2 3. The best management approach for this condition
for the case of Mr. DM would be management of the risk factors of cardiovascular management.
It should be noted that the greatest risk factor for chronic kidney disease would be death from
cardiovascular illnesses or diabetic complications.1 Most cases of CDK can be managed without
referrals to nephrologists. Referral for neurologist is usually recommended when patients are
noticed to have acute kidney failure, with a glomerular filtration rate of not less than 30
mL/min/1.72 m2.
Osteoarthritis (OA) is a disease that destabilizes biological and mechanical events of the body
that often leads to a decline in the production of articular cartilage of the sub-chondral bone.5 The
severity of this condition could get worse for Mr. MD due to the age factor.
Gout is a form of inflammatory arthritis that is known to be very painful.3 This disease occurs in
the even where deposits of hyperemic monosodium uprate crystals are found to be deposited in
tissues and joints. It has been observed that almost 40% of patients with gout haven been found
to have CKD.8 Incidence of gout has been known to increase as the functions of the kidneys
decrease. While there is no much evidence that gout can be precipitated by from gemcitabine
chemotherapy, the Therapeutic guideline recommends carrying this therapy moderately with
measured medications of prophylactic in order to precipitate gout to a manageable remission
status, coupled with administering of the prophylactic medications which would involve
100%mg of allopurinol by mouth daily and 0.6%mg of colchicine by mouth daily.9 This