Mrs. K is concerned about her 14-year-old daughter's weight gain over the past year
Following a thorough assessment the nurse practitioner informs her that her daughter has a BMI of 28 and fasting glucose level of 125, which classifies her as pre-diabetic. She recommends: 1. Weight loss of 5–10%, low-fat diet, and moderate exercise for prevention of type 2 diabetes.
2. A high-fiber diet, strenuous exercise daily, and weight loss of > 20%.
3. Immediate referral to an endocrinologist for further evaluation.
4. No action since a fasting blood sugar of 125 is not abnormal.
1
Rationale: The American Diabetes Association recommends lifestyle changes including weight loss of 5 to 10%, following a diet for reducing cardiovascular risk, and 150 minutes/week of moderate exercise to prevent the development of type 2 diabetes. In the Nurses' Health study, a healthy diet high in cereals and polyunsaturated fats was more strongly associated with lower risk of diabetes among minorities. An immediate referral to the endocrinologist is not warranted unless the nurse practitioner suspects another underlying condition contributing to the problem. Pre-diabetes is defined as a fasting blood sugar between 100 and 125.
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