Diabetes HFP

face to face “F2F” seen with wife, Susan. Type 2 diabetes, duration 10 years. HbA1c 65 mmol/mol, previous result 72 mmol/mol. Medications: Metformin 1000mg twice daily, Gliclazide 80mg twice daily. Non-HDL 3.5 mmol/L, QRisk 10%, taking Atorvastatin 20mg daily, compliant. Urine ACR 2.0 mg/mmol, on Ramipril. BP 130/80 mmHg. Patient reports feeling well with their diabetes, no significant issues. Self-recorded sugar levels: fasting levels between 6-8 mmol/L, post-meal levels between 8-10 mmol/L. No hypos reported. Insulin: Novorapid 6 units before meals, Lantus 20 units at bedtime. CGM: Time in range 70%, time above range 25%, time below range 5%. Noted overnight lows. Medication compliance: Excellent. Patient goals: To maintain HbA1c below 58 mmol/mol. Plan: 1. Continue current medications. 2. Review HbA1c in 3 months. 3. Reinforce healthy eating and exercise advice. 4. Next diabetes review due in 6 months. History: - Presented with a cough for 2 weeks. - ICE: Patient is concerned about the cough and wants to rule out any serious cause. - Presence or absence of red flag symptoms relevant to the presenting complaint: No red flag symptoms. - Relevant risk factors: Smoker, 20 cigarettes per day. - PMH: / PSH: - Type 2 diabetes, hypertension. - DH: Drug history/medications: Metformin, Gliclazide, Atorvastatin, Ramipril. Allergies: NKDA. - FH: Relevant family history: Father with heart disease. - SH: Social history: Smoker, lives with wife. Examination: - Chaperone offered and present. - Vital signs listed: BP 130/80 mmHg, HR 78 bpm, RR 16 breaths/min, Sats 98% on room air, Temp 37.0°C. - Physical or mental state examination findings: Chest clear to auscultation. - Investigations with results: Chest X-ray ordered. Impression: Cough. Assessment: Acute bronchitis. - Differential diagnosis for Issue: Pneumonia. Plan: - Investigations planned for Issue: Chest X-ray. - Treatment planned for Issue: Advised rest, fluids, and paracetamol for symptomatic relief. - Relevant referrals for Issue: Advised to return if symptoms worsen or if any red flag symptoms develop.