Endocrinology

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...

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...

CME ARTICLE

FULL DISCLOSURE POLICY AFFECTING CME ACTIVITIES
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Miller has indicated that he has not received financial support for consultat...

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 ...

Geriatric medicine has clearly come of age within the past 20 years. Not only have the research insights, care approaches, and clinical skills been promoted within different practice environments but also very innovative approaches to the care of older persons have been developed. We can point to the increasing prominence of geriatric medicine as a discipline, but our patients, their families, and our colleagues would all benefit from a clearer identification of our potential role in the care of older adults. How many of us have been asked, “What does a geriatrician do?” and “At what ...

Common sense would dictate that by 2004, given the well-recognized prevalence of chronic illness among the elderly, coordination of geriatric care would be long established as billable under Medicare. As we know all too well, however, the incentives clearly lean toward acute, episodic care and do not encourage the sustained, extensive oversight that good primary care physicians and other health professionals must employ to successfully manage chronic disease in older adults.

We are familiar with the manifestations of common chronic diseases. We know that diabetes, heart disease, and...

Managing the care of older adults at risk for frailty and disability is very complex and time consuming. Preventive care for older adults is the first line of defense in recognizing the potential for developing chronic conditions that can further complicate care and lessen quality of life. In many cases, long-term effective management of these conditions across care settings begins because of thorough preventive care. Geriatric assessment can identify looming health problems early, enabling health care professionals to better devise plans of care and coordinate their delivery.

Becau...