Prognosis for Janice

Janice is a 45yo Caucasian female with symptoms of Non Alcoholic Fatty Liver Disease. Her BMI is 40 and she was diagnosed with DM type 2 3 years ago. Her last HgbA1c was 7.4. She lives a sedentary life style. She state she has significant fatigue and but is otherwise asymptomatic. What diagnostics would you order for Janice? Why? What treatment plan would you recommend for her? What is her prognosis? 2 references APA 7th edition

Treating Non ETOH fatty liver disease.NP.Nov2015.pdf 

For Janice, given her symptoms and medical history, the following diagnostics would be appropriate:

1. Liver Function Tests (LFTs): These tests measure levels of enzymes and proteins in the blood that indicate how well the liver is functioning. Abnormal levels can indicate liver damage or disease, such as Non-Alcoholic Fatty Liver Disease (NAFLD).
2. Ultrasound or Imaging Studies: An ultrasound or other imaging studies like MRI or CT scan can provide visual confirmation of fatty deposits in the liver and assess the severity of liver damage.
3. Fasting Blood Glucose and Insulin Levels: Given her diagnosis of type 2 diabetes mellitus (DM type 2), monitoring fasting blood glucose and insulin levels can help assess glycemic control and insulin resistance, which are closely linked to NAFLD.
4. HbA1c Test: This test provides an average of blood sugar levels over the past 2-3 months and is a good indicator of glycemic control in diabetic patients. Janice’s HbA1c level of 7.4 indicates her blood sugar levels are not optimally controlled.
5. Liver Biopsy (Optional): In some cases, a liver biopsy may be recommended to assess the extent of liver damage and to rule out other liver conditions.

Based on the diagnostic results and Janice’s clinical presentation, the following treatment plan may be recommended:

1. Weight Loss and Lifestyle Modifications: Given Janice’s high BMI and sedentary lifestyle, weight loss through a combination of dietary changes and increased physical activity is crucial. A gradual weight loss of 1-2 pounds per week is generally recommended to minimize the risk of complications.
2. Dietary Changes: Janice should follow a balanced, low-fat diet rich in fruits, vegetables, whole grains, and lean protein. Avoiding sugary and processed foods is essential, as is limiting alcohol intake.
3. Exercise Program: Janice should aim for at least 150 minutes of moderate-intensity aerobic exercise per week, as recommended by guidelines for diabetes management. Incorporating both aerobic and strength training exercises can help improve insulin sensitivity and aid in weight loss.
4. Medication Management: Depending on Janice’s blood glucose and insulin levels, adjustments to her diabetes medications may be necessary to achieve better glycemic control. Medications such as metformin, GLP-1 receptor agonists, or SGLT-2 inhibitors may be considered.
5. Regular Monitoring: Janice should undergo regular monitoring of liver function tests, blood glucose levels, and HbA1c to assess treatment efficacy and adjust management strategies as needed.
6. Patient Education and Support: Providing Janice with education about NAFLD, its risk factors, and the importance of adherence to lifestyle modifications and medications is essential for long-term management.

Prognosis for NAFLD varies depending on the extent of liver damage, presence of comorbidities such as diabetes, and adherence to treatment and lifestyle modifications. With timely intervention and effective management, including weight loss and glycemic control, Janice’s prognosis can be improved, reducing the risk of progression to more severe liver disease such as non-alcoholic steatohepatitis (NASH) and cirrhosis.

References:

1. Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., & Cusi, K. et al. (2012). The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology, 55(6), 2005-2023. doi: 10.1002/hep.25762
2. American Diabetes Association. (2020). 6. Glycemic Targets: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement 1), S66-S76. doi: 10.2337/dc20-S006