A 66-year-old woman comes to the physician for a routine health maintenance examination. She feels well but is unhappy about being overweight. She has tried to lose weight for several years without success. She goes for a walk 3 times a week but she has difficulty following a low-calorie diet. She has type 2 diabetes mellitus and osteoarthritis. Her only current medication is metformin. She has never smoked. She is 160 cm (5 ft 3 in) tall and weighs 100 kg (220 lb); BMI is 39 kg/m2. Vital signs are within normal limits. Hyperpigmentation in skinfolds is noted at the neck as shown in the image below. Serum studies show an HbA1c of 9.5%, and a fasting serum glucose concentration of 158 mg/dL. Elevated serum levels of which of the following substances are most likely contributing to this patient's disease process?

Question

A 66-year-old woman comes to the physician for a routine health maintenance examination. She feels well but is unhappy about being overweight. She has tried to lose weight for several years without success. She goes for a walk 3 times a week but she has difficulty following a low-calorie diet. She has type 2 diabetes mellitus and osteoarthritis. Her only current medication is metformin. She has never smoked. She is 160 cm (5 ft 3 in) tall and weighs 100 kg (220 lb); BMI is 39 kg/m2. Vital signs are within normal limits. Hyperpigmentation in skinfolds is noted at the neck as shown in the image below.  Serum studies show an HbA1c of 9.5%, and a fasting serum glucose concentration of 158 mg/dL. Elevated serum levels of which of the following substances are most likely contributing to this patient's disease process?

Quizplus · Accepted Answer

Eductional Objective: Type 2 diabetes mellitus is due to insulin resistance and relative insulin deficiency.  Chronically elevated free fatty acid levels contribute to insulin resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis.

A 66-Year-Old Woman Comes to the Physician for a Routine