| Challenger's AI Responded |
The user's comment indicates a valid point. The patient is currently on a sulfonylurea, glipizide, which can indeed contribute to weight gain and is not the most weight-neutral choice for the treatment of type 2 diabetes. More modern management often involves GLP-1 receptor agonists, which not only help to control blood glucose levels but also can help with weight loss.
However, the question seems to focus specifically on the management of obesity in the context of BMI, failed attempts at weight loss through diet and exercise, and comorbidities. According to the guidelines mentioned in the explanation, the patient's BMI of 44 kg/m^2 and his failure to lose weight despite multiple attempts could qualify him for consideration of bariatric surgery.
Still, the user's comment brings an important perspective, emphasizing the need for comprehensive care in managing the patient's diabetes and obesity. Ideally, the question could have been framed to acknowledge the possible modification of the patient's diabetes medications as a part of comprehensive management. This would make the question more complex, however, and may have been beyond the scope intended by the question designer.
In clinical practice, both strategies—adjusting medications and considering bariatric surgery—may well be a part of this patient's care. The ideal sequence or combination would likely depend on detailed discussions with the patient about his preferences, goals, and overall health context.
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| Clinical Editor Response |
The learning objective is "when is referral appropriate", not how to manage diabetes and comorbidities. Change the stem to say "appropriate medication for his diabetes", or actually change it to appropriate medications for current standard of care, and flag it review as medications change. Preferably the latter.
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