Good day students!

Please read the case scenario and answer the questions on it. You answer the questions as a group
(1 answer only), but turning-in is individual. All of you must turn in one copy of your answer.
Thank you and God bless!

1. A 50 year old woman, overweight, presents to your clinic complaining of

polyuria/nocturia and weakness. She has a family history of hypertension and diabetes.
On physical examination, she has benign acanthosis nigricans on the neck. Laboratory
test shows fasting blood glucose of 140 mg/dl and HbA1c of 6.0%.

A. What is the most likely diagnosis?

The most likely diagnosis is Diabetes Mellitus. Acanthosis nigricans is a velvety, darkening of
the skin that usually occurs in intertriginous areas. This hyperpigmentation has poorly defined
borders, usually occurs in skin fold areas, such as the back of the neck, axilla, and groin, and may
include thickening of the skin. Acanthosis nigricans is most commonly associated with diabetes and
insulin resistance, but rarely it can be a sign of internal malignancy.Prediabetes for fasting blood
glucose is 100-125 mg/dl and above or equal to 126 mg/dl signifies diabetes. The client also has one
of the classic symptoms of DM which is polyuria.

B. What is the next best step?

While acanthosis nigricans are often benign, the healthcare provider will assess its severity
and distribution. In some cases, especially if acanthosis nigricans is severe or appears suddenly,
further investigation might be needed to rule out underlying conditions, such as hormonal disorders
or certain cancers. If diabetes is diagnosed or if there are risk factors (such as obesity), the
healthcare provider will likely discuss lifestyle modifications. This can include dietary changes,
regular physical activity, and weight management.

C. What is the best initial therapy?

The best initial therapy is diet combined with exercises as possible. Oral hypoglycemic agent
or Insulin treatment such as Metformin. Metformin is the initial drug of choice in patients with type 2
diabetes mellitus.
 D. What is the best initial medical therapy?

The best initial medical therapy is metformin because it is a proven and tested drug that
has been in use for many years. Due to its glycemic effectiveness, metformin is preferred as an
initial treatment