Station 86
Alan Gregory
Age: 40 years old male
Full Case
Patient’s Data
Patient’s name: Alan Gregory
Age: 40-year-old male
Past medical history:
- None recorded
Drug and Allergy History
- Not currently on any medication
- No Known Drug Allergy
Recent Notes/Consultation
Note entry 3 days ago by Dr Andrew Ashburn (Clinical practitioner access role)
- Recall for routine NHS Health Check (aged 40+).
- Text message sent to patient to have routine blood test. Patient booked to have blood test with HCA – Ms. Joanne Badley
Seen yesterday by Ms Joanne Badley (Health care assistant role)
Blood samples taken as requested
Blood pressure: 130/80 mmHg. BMI: 30
Blood test results
Urea and Electrolytes, eGFR, Full Blood Count, Liver Function Test, Thyroid Function Test, and CRP all reviewed and filed as normal by Dr Andrew Ashburn.
The below blood results are still awaiting review and filing.
| Test | Result | Reference Range |
|---|---|---|
| HbA1c | 46 mmol/mol | <42 mmol/mol = Normal |
| Total Cholesterol | 5.8 mmol/L | <5.0 mmol/L (desirable) |
| LDL Cholesterol | 3.9 mmol/L | <3.0 mmol/L |
| HDL Cholesterol | 1.3 mmol/L | >1.0 mmol/L |
| Triglycerides | 1.4 mmol/L | <1.7 mmol/L |
| QRISK3 Score (10-year risk) | 5.5% | – |
Note: Patient was sent a text message inviting them to book an appointment to discuss blood test results. Patient booked a telephone consultation to discuss recent blood test results.
Patient's Story (Role player’s brief)
Patient’s Story
You are Alan Gregory, a 40-year-old male. You are attending this telephone consultation to discuss the results of a recent blood test, which was arranged as part of a routine NHS Health Check.
Opening Statement: “Hi Doctor, I had a blood test a few days ago as part of my NHS check-up, and I got a message asking me to book this appointment.
If asked further: You are not experiencing any symptoms. You had the test because it was offered as part of the NHS health check for people 40 and over.
Family History: Your father has type 2 diabetes.
Social History: You work as an IT professional and mostly work from home. Your job involves sitting for long hours. You do not currently exercise, and your diet includes a lot of fast food and snacks. You live alone.
Ideas: You are not sure what the results will show.
Concerns: You have no specific concerns.
Expectations: You would like to go through your results.
Question for the doctor:
If the doctor explains that you are at risk of developing diabetes or fall within the pre-diabetic range, ask whether there is any medication that could help reduce your risk of progressing to type 2 diabetes.
Say NO to any other questions asked outside of the details already provided in the scenario. Accept anything offered to you by the doctor.
Marking Scheme
Data Gathering and Diagnosis
- Confirm the reason for having the blood test.
- Ask about symptoms to rule out undiagnosed diabetes, including blurred vision (diabetic retinopathy), increased thirst, frequent urination, increased appetite, weight loss or gain, non-healing wounds, tingling in the hands or legs (diabetic neuropathy).
- Ask about any chest pain or shortness of breath (Cardiovascular complications of diabetes)
- Ask about social and lifestyle factors, including smoking, alcohol intake, diet, weight, physical activity level, and occupation.
- Ask about family history of diabetes or other medical conditions.
- Explore the patient’s ideas, concerns, and expectations (ICE).
- Explain that the blood test shows pre-diabetes and raised cholesterol, but with a low QRISK3 score. Also inform the patient of his raised BMI.
Example of explanation to patient
Thanks for coming in to discuss your blood test results, Alan. We ran a full set of routine checks, including your liver function, kidney function, thyroid levels, full blood count, and inflammation markers, and I’m pleased to say all of those came back within the normal range.
We also checked your blood sugar levels and cholesterol. Your blood sugar level sits in a range we call “pre-diabetes.” This means your blood sugar is higher than normal, but not high enough to be classed as diabetes.
Are you following so far? Have you come across the term diabetes before? What do you know about it?
Diabetes is a condition where the body struggles to keep blood sugar levels within a healthy range.
We also checked your cholesterol levels, and they came back a little higher than the healthy range. This just means there is slightly more fat in the blood, which over time can affect the health of your heart and blood vessels.
We also calculated your BMI, which gives us a general idea of weight in relation to height. It is a bit above the recommended range, and that might be playing a role in the higher cholesterol and blood sugar levels we are seeing.
That said, when we put all your results into a risk calculator called a QRISK3 score, your overall risk of having a heart attack or stroke in the next ten years is still low, at 5.5%.
To give some context, that means if 100 people had the same results and risk factors as you, about 5 or 6 of them might go on to have a heart-related problem over the next 10 years. So, while the risk is not high, these results are an early sign that we should pay attention now, so we can keep you as healthy as possible in the long run.
Would it be okay if we talked through what steps you can take to help bring these numbers down and reduce your risk?
We know from lots of research that increasing physical activity can really help reduce blood sugar levels, lower cholesterol, and improve overall health. Simple things like walking more, cycling, or choosing the stairs instead of the lift can make a big difference over time. Do you think you could build in a bit more movement into your routine, even with your busy schedule?
You also mentioned that your diet is not ideal at the moment, which is completely understandable. Balancing work and eating well can be a real challenge, you are not alone in that. But even small changes can help. Eating more fibre and vegetables, and cutting back on foods high in unhealthy fats, can support better blood sugar and cholesterol control. Is that something you feel you could gradually work on?
Some people find that planning and preparing meals ahead of time helps. I can send you a leaflet with simple, healthy meal ideas to get started.
Also, we have a programme called the NHS National Diabetes Prevention Programme. It is designed for people just like you, whose blood sugar is in the pre-diabetic range. It is a supportive, evidence-based course that helps you make long-term lifestyle changes, and it is available both online and face-to-face. I would really recommend it, and I would be happy to refer you if you are interested.
How does that sound to you?
You asked whether we could prescribe medication to help prevent diabetes, and that is a really good question. In most cases like yours, we start by focusing on lifestyle changes first. Things like improving your diet, increasing physical activity, and working towards a healthy weight can be very effective in bringing blood sugar and cholesterol levels down.
We will continue to monitor your progress with regular check-ups, and if at any point anything changes or gives us cause for concern, we can look at further options together.
Management
Management
- Offer lifestyle advice, including adopting a healthy diet by reducing saturated fat intake, increasing dietary fibre, and improving physical activity levels.
- Encourage at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or cycling.
- Reassure the patient that medication is not routinely recommended for pre-diabetes, as most people can reverse it with lifestyle changes.
- Refer to the NHS National Diabetes Prevention Programme — a nine-month, evidence-based lifestyle intervention that can be attended digitally, face-to-face, individually, or in a group.
- Offer further tests including a full lipid profile, BMI measurement, and QRISK3 calculation to assess cardiovascular risk
- Inform the patient that HbA1c will be monitored annually to track long-term progress.
- Arrange a follow-up in 3 months to review lifestyle changes and assess whether additional interventions, such as weight management support or medication for obesity (e.g. orlistat), are required.
- Advise the patient to seek medical review if he develops symptoms suggestive of diabetes, such as increased thirst, frequent urination, unexplained weight loss, or persistent fatigue.
Learning point from this station:
Pre-diabetes and raised cholesterol are common incidental findings during routine NHS Health Checks and can often be managed effectively in primary care. As primary care clinicians, it is important to promote prevention and early intervention.
When discussing sensitive topics such as weight, diet, or physical activity, communication should always be patient-centred and non-judgemental. Patients should be reassured that pre-diabetes is often reversible through sustained lifestyle changes, particularly a healthier diet and increased physical activity.
The combination of pre-diabetes, raised BMI, and elevated cholesterol may raise suspicion of metabolic syndrome, a cluster of conditions that increase the risk of cardiovascular disease and type 2 diabetes. However, the clinical usefulness of the metabolic syndrome label has been debated. In practice, the emphasis should remain on individual cardiovascular risk reduction through proactive lifestyle management and appropriate monitoring.