Aging with Diabetes—An Underappreciated Cause of Progressive Disability and Reduced Quality of Life
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Pages 45 - 53
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 by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation Statement
The Johns Hopkins University School of Medicine designates this education activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Valid October 1- December 31, 2004. Estimated time: 1 hour
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 sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Pinkstaff has indicated that she has not received financial support for consultation, research or evaluation or has a financial interest relevant to this article. No faculty member has indicated that their presentation will include information on off-label products.
DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
Educational Objectives
1. To understand the pivotal importance and negative impact of diabetes on functional status, quality of life, development of progressive disability, and life expectancy in older adults
2. To be able to recognize and clinically monitor the six most common geriatric syndromes in older adults with diabetes
3. To learn to implement tools for the assessment of depression, impairment in lower extremity functioning and risk for falls, adverse consequences of polypharmacy, and ability for self- management of diabetes
4. To be able to recommend effective pharmacologic and rehabilitative treatments for older adults with diabetes
Instructions
A certificate of completion will be awarded to physicians completing the posttest and evaluation form. Please complete the following examination answer sheet and mail it with your payment of $10 (write the course number OFP# 55-0615 on your check payable to Johns Hopkins-Office of Funded Programs) to:
Johns Hopkins University School of Medicine
Office of Funded Programs
P.O. Box 64749
Baltimore, MD 21264-4749
You will receive the certificate of completion approximately 6-8 weeks after submitting your materials, and receiving a grade of 70% or higher. Requests for CME credits must be received within 90 days of the publication date of the issue; void after that date.
References1. National Diabetes Fact Sheet. Available at: www.cdc.gov/ diabetes/pubs/factsheet.htm. Accessed July 5, 2004.2. Cowie CC, Rust KF, Byrd-Holt D. Prevalence of diabetes and impaired fasting glucose in adults-United States, 1999-2000. JAMA 2003;290:1702-1702.3. Narayan KM, Boyle JP, Thompson J, et al. Lifetime risk for diabetes mellitus in the United States. JAMA 2003;290: 1884-1890.4. Wandell PE, Tovi J. The quality of life of elderly diabetic patients. J Diabetes Complications 2000;14:25-30.5. Lubitz J, Cai L, Kramarow, Lentzner H. Health, life expectancy, and health care spending among the elderly. N Engl J Med 2003;349:1048-1055.6. Gregg EW, Engelgau M, Narayan V. Complications of diabetes in elderly people. BMJ 2002;325:916-917.7. Guidelines for Improving the Care of the Older Person with Diabetes Mellitus. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. J Am Geriatr Soc 2003;51:S265-S280.8. La Croix AZ, Newton KM, Leveille SG, et al. Healthy aging: A woman’s issue. West J Med 1997;167:220-232.9. Bierman AS, Clancy CM. Health disparities among older women: Identifying opportunities to improve quality of care and functional health outcomes. JAMWA 2001;56:155-159.10. Physical Activity and Health. Available at: www.cdc.gov/ physical/nccdphp/sgr/sgr.htm. Accessed July 5, 2004.11. Anderson R, Freedland K, Clouse RE, et al. The prevalence of comorbid depression in adults with diabetes. Diabetes Care 2001;24: 1069-1078.12. Gavard JA, Lustman PJ, Clouse RE. Prevalence of depression in adults with diabetes: An epidemiological evaluation. Diabetes Care 1993;16:1167-1178.13. Finkelstein EA, Bray JW, Chen H. et al. Prevalence and costs of major depression among elderly claimants with diabetes. Diabetes Care 2003;26:415-420.14. Ciechanowski PS, Katon WJ, Russo J. Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000;160:3278-3285.15. Gerich J. Clinical significance, pathogenesis, and management of postprandial hyperglycemia. Arch Intern Med 2003;163;1306-1316.16. Lustman PJ, Anderson RJ, Freedland KE, et al. Depression and poor glycemic control. Diabetes Care 2000;23: 934-942.17. Lustman PJ, Griffith LS, Freedland KE, et al. Cognitive behavior therapy for depression in type 2 diabetes mellitus. Ann Intern Med 1998;129:613-621.18. Lustman PJ, Freeland KE, Griffith LS, et al. Fluoxetine for depression in diabetes: A randomized double-blind placebo- controlled trial. Diabetes Care 2000;23: 618-623.19. Lustman PJ, Griffith LS, Clouse RE, et al. Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial. Psychosom Med 1997;59: 241-250.20. Sheikh JI, Yesavage JA. Geriatric depression scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol 1986;5:165-172.21. Amin SH, Kuhle CL, Fitzpatrick LA. Comprehensive evaluation of the older woman. Mayo Clin Proc 2003;78: 1157-1185.22. Fontbonne A, Berr C, Ducimetiere P, et al. Changes in cognitive abilities over a 4 year period are unfavorably affected in elderly diabetic subjects. Diabetes Care 2001;24:266-370.23. Strachan MWJ, Deary IJ, Ewing FME, et al. Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies. Diabetes Care 1997;20:438-445.24. Sinclair AJ, Girling AJ, Bayer AJ. Cognitive dysfunction in older subjects with diabetes mellitus: Impact on diabetes self-management and use of care services. Diabetes Research Clinical Practice 2000;50:203-212.25. Gregg EW, Yaffe K, Cauley JA, et al. Is diabetes associated with cognitive impairment and cognitive decline among older women? Arch Intern Med 2000;160:174-180.26. Logroscino G, Kang JH, Grodstein F. Prospective study of type 2 diabetes and cognitive decline in women aged 70-81 years. BMJ 2004;328:548-551.27. Gregg EW, Beckles GL, Williamson DF, et al. Diabetes and physical disability among older US adults. Diabetes Care 2000;23: 1272-1277.28. Ryerson B, Tierney EF, Thompson TJ, et al. Excess physical limitations among adults with diabetes in the U.S. population, 1997-1999. Diabetes Care 2003;26:206-210.29. Langlois JA, Keyl PM, Guralnik JM, et al. Characteristics of older pedestrians who have difficulty crossing the street. Am J Public Health 1997;87:393-397.30. Podsiadlo D, Richardson S. The Timed “Up & Go:” A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-148.31. Schwartz AV, Hillier TA, Sellmeyer D, et al. Older women with diabetes have a higher risk of falls. Diabetes Care 2002;25: 1749-1754.32. Schwartz AV, Sellmeyer DE, Ensrud KE, et al. Older women with diabetes have an increased risk of fracture: A prospective study. J Clin Endocrinol Metab 2001;86:32-38.33. Gregg EW, Mangione CM, Cauley JA, et al. Diabetes and incidence of functional disability in older women. Diabetes Care 2002;25: 61-67.34. Volpato S, Ferrucci L, Blaum C, et al. Progression of lower extremity disability in older women with diabetes. Diabetes Care 2002;26:70-75.35. Good CB. Polypharmacy in elderly patients with diabetes. Diabetes Spectrum 2002;15:240-248.36. Dailey GE. Hypoglycemia in elderly patients treated with oral agents. Practical Diabetology June 2002:7-14.37. Shorr RI, Ray WA, Daughtery JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylurea. Arch Intern Med 1997;157:1681-1686.38. American Geriatrics Society Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc 2002;50(Suppl 6):S205-S224.39. Holroyd-Leduc JM, Straus SE. Management of urinary incontinence in women. JAMA 2004;291:986-995.40. Estabrooks PA, Glasgow RE, Dzewaltowski DA. Physical activity promotion through primary care. JAMA 2003;289: 2913-2916.41. Gregg EW, Gerzoff RB, Caspersen CJ, et al. Relationship of walking to mortality among US adults with diabetes. Arch Intern Med 2003;163:1440-1447.42. Hu FB. Walking-The best medicine for diabetes? Arch Intern Med 2003;163:1397-1398.43. Boule NG, Hadda E, Kenny GP, et al. Effects of exercise on glycemic control and body mass in type 2 diabetes: A meta-analysis of controlled clinical trials. JAMA 2001;286: 1218-1227.44. American Diabetes Association Clinical Practice Recommendations: Physical Activity/Exercise and Diabetes. Diabetes Care 2004;27: S58-S62.45. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407.46. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Pittsburgh, PA: Superintendent of Documents; 1996.47. Fries JF. Reducing disability in older age. JAMA 2002;288: 3164-3165.







