Prevalence, Clinical Presentation And Diagnosis, Complications, Treatment, Management Of Hypertension And Excess LipidsPerspective
Diabetes mellitus is a failure to control blood sugar levels so that they become too high. It is classified into two categories. Type 1 diabetes (also called juvenile diabetes) is characterized by an acute destruction of insulin-secreting beta cells in the pancreas by autoantibodies. Insulin is a hormone essential to maintaining blood sugar at a normal level. Diabetes results in the abolition of insulin secretion by the pancreas, severe hyperglycemia (high blood sugar) and production of ketones. Type 2 diabetes (also called adult onset diabetes) is characterized by a gradually increasing blood sugar level resulting from a combination of resistance to the action of insulin at the cellular level and a gradual decline of insulin secretion by the pancreas.
Diabetes mellitus is a common disease in the older population. The vast majority of elderly subjects have type 2 diabetes, which means that the degree of hyperglycemia is variable and rarely results in the production of ketones. Since the degree of hyperglycemia is variable and elderly subjects are often not aware of the symptoms of high blood sugar (see below), there may be a few years of asymptomatic disease before a diagnosis of diabetes is made.
Considering the aging trend in American society, an increased prevalence of diabetes is expected among the elderly population. The economic and sociological impacts of this health problem will dramatically increase by the middle of the twenty-first century. More research will be necessary to understand the disease and the mechanisms involved in the progression of associated complications.
DANIEL TESSIER TAMAS FÜRLÖP GRAYDON S. MEINELLY
AGURS-COLLINS, T. D.; KUMANYIKA, S. K.; TEN HAVE, T. R. et al. "A Randomized Controlled Trial of Weight Reduction and Exercise for Diabetes Management in Older African-American Subjects." Diabetes Care 20 (1997): 1503–1511.
American Diabetes Association. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. "Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus" 20 (1997): 1183–1197. BRODOWS, R. G. "Benefits and Risks with Glyburide and Glipizide in Elderly NIDDM Patients." Diabetes Care 15 (1992): 75–80.
CURB, J. D.; PRESSEL, S. L.; CUTLER, J. et al. "Effect of Diuretic Based Antihypertensive Treatment on Cardiovascular Risk in Older Diabetic Patients with Isolated Systolic Hypertension." Journal of the American Medical Association 276 (1996): 1886–1892.
GOLDBERG, R. B.; MELLIES, M. J.; SACKS, F. et al. "Cardiovascular Events and Their Reduction with Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors with Average Cholesterol Levels: Subgroup Analyses on the Cholesterol and Recurrent Events (CARE) Trial." Circulation 98 (1998): 2513–2519.
HARRIS, M. I.; FLEGAL, K. M.; COWIE, C. C. et al. "Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults. The Third National Health and Nutrition Examination Survey, 1988–1994." Diabetes Care 21 (1998): 518–1924.
KUUSISTO, J.; MYKKANEN, L.; PYORALA, K. et al. "NIDDM and Its Metabolic Control Predict Coronary Heart Disease in Elderly Subjects." Diabetes 43 (1994): 960–967.
LALAU, J. D.; VERMERSCH, A.; HARY, L. et al. "Type 2 Diabetes in the Elderly: An Assessment of Metformin." International Journal of Clinical Pharmacology and Therapeutic Toxicology 28 (1990): 329–332.
LIPID Study Group. "Prevention of Cardiovascular Events and Death with Pravastatin in Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol Levels." New England Journal of Medicine 339 (1998): 1349–1357.
MENEILLY, G. S.; CHEUNG, E.; TESSIER, D. et al. "The Effect of Improved Glycemic Control on Cognitive Functions in the Elderly Patient with Diabetes." Journal of Gerontology 48 (1993): M117–M121.
MENEILLY, G. S.; RYAN, E. A.; RADZUIK, eJ. et al. "Effect of Acarbose on Insulin Sensitivity in Elderly Patients with Diabetes." Diabetes Care 23 (2000): 1162–1167.
MELTZER S.; LEITER, L.; DANEMAN, D.; GERSTEIN,HJ. C. et al. "1998 Clinical Practice Guidelines for the Management of Diabetes in Canada." Canadian Medical Association Journal 159 (8 suppl) (1998): S1–S29.
MORISAKI, N.; WATANABE, S.; KOBAYASHI, J. et al. "Diabetic Control and Progression of Retinopathy in Elderly Patients: Five-Year Follow-up Study." Journal of the American Geriatric Society 42 (1994): 142–145.
PYORALA, K.; PEDERSEN, T. R.; KJEKSHUS, J. et al. "Cholesterol Lowering with Simvastatin Improves Prognosis of Patients with Coronary Heart Disease: A Subgroup Analysis of the Scandinavian Simvastatin Survival Study (4S)." Diabetes Care 20 (1997): 614–620.
REAVEN, G. M., and STAFF OF THE PALO ALTO GRECC AGING STUDY UNIT. "Beneficial Effects of Weight Loss in Older Patients with NIDDM." Journal of American Geriatric Society 33 (1985): 93–95.
ROCKWOOD, K.; TAR, M. H.; PHILLIPS, S.; and MCDOWELL, I. "Prevalence of Diabetes Mellitis in Elderly People in Canada." Age Ageing 27 (1998): 573–577.
TESSIER, D.; DAWSON, K.; TETRAULT, J. P. et al. "Glibenclamide vs. Gliclazide in Type 2 Diabetes of the Elderly." Diabetic Medicine 11 (1994): 974–980.
TOVI, J., and ENGFELDT, P. "Well-being and Symptoms in Elderly Type 2 Diabetes Patients with Poor Metabolic Control: Effect of Insulin Treatment." Practical Diabetes International 15 (1998): 73–77.
TUOMILEHTO, J.; RASTENYTE, D.; BIRKENHAGER, W. H. et al. "Effects of Calcium-Channel Blockade in Older Patients with Diabetes and Systolic Hypertension. Systolic Hypertension in Europe Trial Investigators." New England Journal of Medicine 340 no. 9 (1999): 677–684.
United Kingdom Prospective Diabetes Study. "Intensive Blood Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS33)." Lancet 352, no. 9131 (12 September 1998): 837–853.
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