Problem:
A 65-year-old woman presents with episodes of urinary incontinence for the past 3 days. She had similar episodes 4 months ago that lasted 1 week. A review of systems is positive for vaginal dryness and itching, and negative for burning urination. Her history is significant for type 2 diabetes mellitus, well-controlled with oral metformin and diet. She takes no other medications. She doesn't smoke or drink. Her family history is negative for any neurological conditions. Vital signs are temperature 37.2 C (98.9 F), heart rate 94 bpm, respiratory rate 16 breaths/min, and blood pressure 126/84 mm Hg. On physical examination, there is thinning of vulvar skin and decreased elasticity. Her last HbA1c was 7%, 6 weeks ago. What is the best step in management? Need Assignment Help? A. Start oral glucocorticoids. B. Restricted fluid intake after 6 pm. C. Obtain fasting plasma glucose. D. Vaginal estrogen cream.