[Answered]: After several years of skipping his annual…

After several years of skipping his annual physical appointment, Marvin, a 62-year-old retired White male, was convinced by his family to have a physical exam and OGTT*. Marvin is relatively physically inactive, is in the overweight category, and has elevated blood pressure. His only complaint is waking up during the night to urinate. Upon arrival at the clinic on Tuesday morning, Marvin provides a specimen for urinalysis, which is tested within one hour. The UA result is within normal limits (WNL) for all analytes. The phlebotomist draws a fasting blood glucose sample, then Marvin is instructed to drink the 75-g glucose load. After two hours, another blood sample is drawn and sent to the lab. These are Marvin’s results: Fasting Glucose: 124 mg/dL 2-Hour OGTT: 213 mg/dL On Friday afternoon, Marvin returns after lunch for follow-up testing, and his physician receives this result: HbA1c: 6.8% Based on the patient history and lab values, what is Marvin’s diagnosis? normal results, supported by the normal urinalysis prediabetes type 1 diabetes mellitus type 2 diabetes mellitus unable to determine since the HbA1c result was not performed on a fasting sample Based on the previous question, how do you explain Marvin’s normal urinalysis results upon arrival at the clinic? the specimen was old, and the glucose degraded this makes sense, since the renal threshold (Tm) for glucose is 160-180 md/dL the specimen was not light-protected, and the glucose degraded the specimen was exposed to oxidizing substances Based on Marvin’s results in the first question, List Marvin’s known risk factors for diabetes, according to the ADA. What is the ADA’s recommended frequency for an HbA1c test (how often should Marvin have this test performed)? Explain. What HbA1c goal should the physician recommend for Marvin and why? Explain the benefits of this goal for Marvin’s health. What is the specimen requirement for HbA1c testing, what is the preferred laboratory method, and why is it preferred? Explain why annual albuminuria testing would be recommended in Marvin’s case (what would it tell us?).