GP CCE Cases · metabolic-and-endocrine-health
Obesity with prediabetes progressing to T2DM — CCE clinical encounter
CCE-style clinical encounter: a 48-year-old man with BMI 33, prediabetes and multiple failed diet attempts asks about 'the injection'. The candidate must raise obesity as a chronic disease without stigma, apply DPP lifestyle evidence, discuss GLP-1 pharmacotherapy honestly including supply constraints, explain weight regain biology, and screen for complications.
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Prompt
A 48-year-old accountant attends after his brother was diagnosed with T2DM. His BMI is 33 (waist 108 cm). HbA1c is 6.0% (prediabetes). He has tried Weight Watchers twice, lost 8 kg each time then regained more. He wants 'Ozempic for the weight'. He has no known T2DM. BP 138/86. He mentions he snores loudly and wakes unrefreshed.
Objectives
- Raise obesity using person-first language and permission-based approach. [7]
- Apply DPP evidence to structure a lifestyle intervention plan. [1]
- Discuss GLP-1 pharmacotherapy with honest efficacy data and supply realities. [4] [5]
- Explain weight regain biology to reframe previous diet failures. [9]
- Screen for complications: OSA symptoms, MASLD enzymes, depression. [3]
References6ShowHide
- [1]Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002.PMID 11832527
- [3]Padwal RS, Pajewski NM, Allison DB, Sharma AM Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ, 2011.PMID 21844111
- [4]Flegal KM, Kit BK, Orpana H, Graubard BI Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 2013.PMID 23280227
- [5]Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med, 2013.PMID 23796131
- [7]Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, et al. Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition. Obesity (Silver Spring), 2016.PMID 27136388
- [9]Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med, 2021.PMID 33567185