Aspects of Diabetes Mellitus
Assessment of Psychiatric Disorders Among Older Adults With Diabetes Mellitus
Recent studies have suggested that certain psychiatric disorders occur with increased frequency among older adults with type 2 diabetes mellitus for several reasons.1,2 First, diabetes is considered to be one of the most psychologically and behaviorally demanding of the chronic medical illnesses. Multiple coping strategies are necessary to deal with the losses that can occur with aging. Because 95% of the management of diabetes is conducted by the patient, a diagnosis of diabetes can lead to increased levels of anxiety, depressive symptoms, and lowered self-esteem. This is often true in ind...
Atherosclerotic Vascular Disease and Diabetes in the Older Adult Part II: Rationale and Strategies
In Part I of this two-part article (Clinical Geriatrics 2006;14[1]:17-25), we reviewed the current literature regarding the epidemiology of atherosclerotic vascular disease (ASVD) in older adults with diabetes mellitus, the mechanisms underlying the pathogenesis of atherosclerosis, and the clinical risk factors associated with the development and progression of ASVD in patients with the metabolic syndrome and diabetes. Part II of this article summarizes treatment guidelines designed to reduce risk and prevent progression of ASVD, and suggests recommendations for their applicability in the o...
Atherosclerotic Vascular Disease and Diabetes in the Older Adult; Part I: Understanding Pathogenic Mechanisms
RS is a 75-year-old Caucasian man with essential hypertension and type 2 diabetes mellitus of 7 years duration. He denies diabetic complications and takes only glipizide and atenolol. Physical exam shows weight 218 pounds, height 70”, body mass index 31, blood pressure 152/82 mm Hg, and absent reflexes at the ankles. Patients such as RS, who represent a common office scenario, raise several important questions regarding appropriate treatment:
• What are the risk factors for atherosclerotic vascular disease (ASVD) in this patient?
• Could he already have subclinical dise...
Diabetes Mellitus: Present and Future Preventive Strategies—Part II
Prevention of type 2 diabetes mellitus at a preclinical phase with pharmacologic treatment has been gaining interest. Medications that have been proposed include acarbose, metformin, orlistat, antihypertensives, and the thiazolidinediones (TZDs). The pharmacologic prevention of complications of diabetes using pharmacologic means, or tertiary prevention, is beyond the scope of this discussion. The Study TO Prevent Non–Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) is a double-blind, placebo-controlled, randomized...
