A 64-year-old male presents to his general practitioner for a
health insurance medical and is concerned about his general
health.
He has been otherwise well except for a diagnosis of
hypertension two years ago when he was placed on a diet. He stopped
smoking 10 years ago and drinks approximately 20 units of alcohol
weekly. Currently he takes no medication.
He is concerned that his elder brother has recently been
diagnosed with diabetes mellitus and has commenced oral therapy.
His father and mother also had diabetes and died of stroke and
myocardial infarction respectively.
He also informs you that he is concerned about his weight.
On examination, his BMI is 33.4 kg/m2, pulse is 82
beats per minute, with a blood pressure of 148/92 mmHg.
Cardiovascular, respiratory and abdominal examination are normal
except for central adiposity.
Investigations reveal:
| Full blood count |
Normal |
| Serum sodium |
138 mmol/l |
(137-144) |
| Serum potassium |
4.4 mmol/l |
(3.5-4.9) |
| Serum urea |
6 mmol/l |
(2.5-7.5) |
| Fasting plasma glucose |
6.4 mmol/l |
(3.0-6.0) |
| Alkaline phosphatase |
135 U/l |
(60-110) |
| Aspartate transaminase |
35 U/l |
(5-35) |
| Serum cholesterol |
5.6 mmol/l |
(<5.2) |
| Serum triglycerides |
3.2 mmol/l |
(0.45-1.69) |
Which of the following is the most appropriate strategy to
reduce the future risk of this patient developing diabetes
mellitus?