Case Briefing for Clinician

This simulation features Sarah Mitchell, a 47-year-old secondary school mathematics teacher presenting following an urgent referral from her optometrist. She has recently attended a workplace health screening which showed elevated blood glucose levels, but she is unaware these results indicate diabetes.

This case tests breaking significant news sensitively, explaining diabetes-retinopathy connections, and developing a collaborative management plan.

Test Results Available to GP (Patient Unaware)

Results from workplace health screening – tested 5 days ago

• HbA1c: 68 mmol/mol (diagnostic of Type 2 Diabetes)
• Random glucose at health check: 14.2 mmol/L
• Blood Pressure: 138/82 mmHg
• Cholesterol: 5.8 mmol/L, LDL 3.9 mmol/L
• eGFR: 78 ml/min (mild reduction)
• Urine ACR: 4.2 mg/mmol (mildly elevated microalbuminuria)
• Eye examination: Background diabetic retinopathy both eyes (optometrist urgent referral received)

Past Medical History

• Hypertension diagnosed 2 years ago (well controlled on medication)
• BMI 32 (has struggled with weight since having children)
• Father died of stroke aged 58 with history of poorly controlled diabetes
• Mother alive and well with no diabetes
• Non-smoker, alcohol approximately 14-21 units per week

Current Medications

• Ramipril 5mg once daily (morning)
• Ibuprofen PRN for occasional headaches