Optimizing Diabetes Outcomes through Multi-Encounter Care: An Urban Case Study

Abstract

Mrs. TY., a 49-year-old female, presented to an urban primary care facility in Johannesburg, South Africa, for her first clinical encounter. She reports persistent fatigue, frequent urination occurring four to five times nightly and occasional episodes owf blurred vision. She admits to missing her evening doses of metformin approximately two to three times per week. Her dietary pattern includes large portions of yam, rice, and fufu accompanied by high-oil soups, and she consumes two to three bottles of soft drinks weekly. She also leads a largely sedentary lifestyle. She denies experiencing chest pain, dizziness, or symptoms suggestive of hypoglycemia. Her fasting blood glucose was significantly elevated at 232 mg/dL. She weighed 82 kg and measured 1.63 m in height, resulting in a body mass index of 31.2 kg/m², which classifies her as obese. Her blood pressure was 144/86 mmHg, indicating suboptimal control. Random urinalysis showed glycosuria but no ketones, consistent with poor glycemic control without acute ketoacidosis. A foot examination revealed no evidence of peripheral neuropathy.