Shelley (the same patient as in coursework 1) is now well controlled with an HbA1c of 50mmol/mol.  Her albumin creatinine ratio is 0.9.  She is an ex-smoker and drinks 20-30 units of alcohol per week and works very long hours preparing her cases for court and representing clients.  She lives alone and relies on restaurants, takeaways and supermarket meal deals to eat.  She says she has no time to exercise.  Her current BMI is 29.1kg/m2.  Her average day time BP reading, from a recent ambulatory BP trace, is 143/87 mm Hg.  Her total cholesterol is 4.8mmol/L and her HDL cholesterol is 1.1mmol/L.  Shelley’s father had diabetes and died of a myocardial infarction aged 57.  This worries Shelley.

Her QRisk score is 15%.

You now need to address the other aspects of diabetes management, with a particular focus on reducing her cardiovascular risk.  Through careful evaluation and analysis of current evidence, and taking a patient-centred approach, discuss

the lifestyle and pharmacological interventions that should be implemented in order to reduce Shelley’s cardiovascular risk.
Discuss the lifestyle and pharmacological interventions that should be implemented in order to reduce adiabetic’s cardiovascular risk.