Question of the Week

For January 4, 2022

A 42-year-old man presents for ongoing management of type 2 diabetes. His diabetes was poorly controlled for several years, but he recently attained a glycated hemoglobin level of 6.8% after starting basal insulin, and self-monitoring of blood glucose levels has shown >90% of fingerstick glucose values within target. He has nonproliferative retinopathy but is asymptomatic. A complete review of systems is negative. In addition to insulin, he takes aspirin 81 mg daily and atorvastatin 80 mg daily.

His blood pressure is 128/76 mm Hg, and his BMI is 32. Neurologic examination identifies diminished Achilles tendon reflexes and diminished sensation in response to light touch and vibration in both feet.

Laboratory evaluation reveals an LDL-cholesterol level of 68 mg/dL (reference range, <130 mg/dL) and 18 mg of albumin per gram of creatinine in a spot urine (<30).

Which one of the following additional evaluations is recommended for this patient?

Measure fructosamine
Order electromyography
Measure serum creatinine
Order cardiac stress testing
Measure C-reactive protein

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