International Journal of Clinical Case Reports 2024, Vol.14, No.4, 175-188 http://medscipublisher.com/index.php/ijccr 178 4 Clinical Case Studies: Current Practices 4.1 Case study 1: management of diabetic neuropathy 4.1.1 Patient background and diagnosis A 55-year-old male patient with a 10-year history of type 2 diabetes mellitus presented with symptoms of numbness, tingling, and burning pain in his lower extremities. The patient reported that the pain was particularly severe at night, affecting his sleep quality. Physical examination revealed decreased sensation in a stocking-glove distribution, and nerve conduction studies confirmed the diagnosis of distal symmetric polyneuropathy, a common form of diabetic neuropathy (Figure 1) (Feldman et al., 2019; Saraswat et al., 2023). 4.1.2 Treatment approach and outcomes The treatment plan included optimizing glycemic control, initiating pregabalin for neuropathic pain, and recommending lifestyle modifications such as regular exercise and smoking cessation. The patient was also referred to a psychologist for cognitive-behavioral therapy to address anxiety and depression associated with chronic pain (Kioskli et al., 2019; Braffett et al., 2020). After six months, the patient reported significant pain relief and improved sleep quality, although some sensory deficits persisted (Shin et al., 2018; Jensen et al., 2021). 4.2 Case study 2: management of diabetic nephropathy 4.2.1 Patient background and diagnosis A 60-year-old female patient with a 15-year history of type 2 diabetes mellitus and hypertension presented with persistent proteinuria and elevated serum creatinine levels. The patient had a history of poor glycemic control, with HbA1c levels consistently above 8%. A kidney biopsy confirmed the diagnosis of diabetic nephropathy (Sasso et al., 2021; Carvajal-Moreno et al., 2022). 4.2.2 Treatment approach and outcomes The treatment strategy involved intensive multifactorial intervention, including strict blood pressure control with ACE inhibitors, improved glycemic control targeting an HbA1c of less than 7%, and lipid-lowering therapy. The patient was also advised to follow a low-protein diet to reduce kidney workload (Xu et al., 2020; Sasso et al., 2021). Over a follow-up period of two years, the patient showed stabilization of kidney function and a reduction in proteinuria, although complete remission was not achieved (Sasso et al., 2021). 4.3 Case study 3: management of diabetic retinopathy 4.3.1 Patient background and diagnosis A 50-year-old male patient with a 12-year history of type 1 diabetes mellitus presented with blurred vision and floaters. Fundoscopic examination revealed multiple microaneurysms, hemorrhages, and neovascularization, consistent with proliferative diabetic retinopathy (Xu et al., 2020). 4.3.2 Treatment approach and outcomes The patient underwent panretinal photocoagulation therapy to prevent further progression of retinopathy. Additionally, intravitreal injections of anti-VEGF agents were administered to reduce macular edema. The patient was also counseled on the importance of maintaining optimal glycemic control and regular ophthalmologic follow-ups. After one year, the patient experienced stabilization of vision and no further progression of retinopathy (Xu et al., 2020). 4.4 Case study 4: management of cardiovascular complications 4.4.1 Patient background and diagnosis A 65-year-old male with a 20-year history of type 2 diabetes mellitus and a previous of myocardial infarction presented with chest pain and shortness of breath. Cardiac evaluation revealed significant coronary artery disease, and the patient was diagnosed with diabetic cardiovascular autonomic neuropathy (Braffett et al., 2020).
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