Diabetes

Supplement to Clinical Geriatrics
A CME Certified Educational Program
NACCME (North American Center for Continuing Medical Education

This activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.

Target Audience:
This program is intended for physicians treating older patients with diabetes.

Credits:
1 AMA PRA Category 1 Credit™

Learning Objectives:
Upon completion of this educational activity, participants should be able to:
• Describe the heterogeneity of the elderly population in defining...

INTRODUCTION
Aging is known to be associated with an increased prevalence of diabetes. In 2005, the Centers for Disease Control and Prevention reported an estimated prevalence of diabetes in the United States to be 2% in the 20-39 age group, 10% in the 40-59 age group, and 21% in the 60 or older age group.1

For type 2 diabetes, the mechanisms responsible can be broadly divided into insulin resistance in target tissues and impaired insulin secretion from beta cells in the pancreas. The pathogenesis of type 2 diabetes is multifactorial; however, hyperglycemia does not develop wit...

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...

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...

CME ARTICLE
ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should cl...

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 trial with an intention-to-treat analysis evaluating high-risk pers...

Diabetes mellitus is a growing concern for the older person. All too often undiagnosed and inappropriately treated, diabetes affects approximately 8% of persons over the age of 65 years and more than 20% of those over age 80. We have come a long way in our understanding of the pathogenesis of this life-threatening and potentially debilitating illness, and new methods of treatment continually become available. Preventing complications of diabetes depends largely on controlling the level of blood sugar, although even with good control certain end-organ effects may be inevitable. Clearly, the ...

This continuing medical education activity is sponsored by the Johns Hopkins University School of Medicine, Baltimore, Maryland. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

These examination questions are based on the article “Aging with Diabetes—An Underappreciated Cause of Progressive Disability and Reduced Quality of Life,” which appears on pages 45-53 in this issue of Clinical Geriatrics.

Accreditation

The Johns Hopkins University School of Medicine is accredited...