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Diabetes and the Older Adult

I am writing this introduction just a week before the annual meeting of the Canadian Geriatrics Society in Toronto (if I did not see you at this meeting, I hope to see you next year!). For what seems like the 100th consecutive year, our society members and last year’s conference attendees rated the topic of diabetes and the older adult as one that they wanted to learn more about. This is not surprising. Research into the management of diabetes seems to be accelerating every year, and the large number of new treatment options makes it difficult for the average physician to keep up. Even more importantly, the prevalence of type 2 diabetes mellitus is increasing because of the large number of overweight older Canadians. The challenge is one that has to be faced by family physicians, general internists, and geriatricians, as well as endocrinologists.

Our CME article this month is on the “Benefits and Risks of Oral Medications in the Treatment of Older Adults with Type 2 Diabetes” by Dr. Ali Rizvi. Those of us who have children will truly appreciate the article “Does Lecturing Older Adults with Diabetes about a Healthy Lifestyle Work?” I do not know if the article’s author, Dr. Carla Miller, has children or whether her lectures to them were ignored the way mine were to my children (they turned out all right). Unlike type 1 diabetes, for which insulin treatment begins immediately, the timing of when, or even if, the older patient should be started on insulin is a complex one. This topic is addressed in the article by Dr. Mae Sheikh-Ali and Dr. Joe Chehade entitled “A Rational Approach to the Initiation of Insulin Therapy in Older Adults.” The final focus article in this edition is a crucial one: “Glycemic Control in Older Adults: Applying Recent Evidence to Clinical Practice” by Drs. Ajay Sood and David Aron.

In addition to our focus on diabetes, we have our usual collection of assorted articles. Our Dementia column actually refers to this month’s theme as well: “Cognitive Dysfunction among Older Adults with Diabetes” by Dr. Hsu-Ko Kuo, Dr. Yau-Hua Yu, Shin-Yu Lien, and Dr. Yi-Der Jiang. With the rising prevalence of diabetes and the enormous cost to the individual, the family, and the health care system, of dementia, the public health consequences of diabetes predisposing to dementia are quite frightening. Our cardiovascular column this month is on the “Initial Evaluation of Causes of Stroke in Frail Older Adults” and is written by Dr. Pippa Tyrell, Dr. Sharon Swain, and Dr. Anthony Rudd.

Enjoy this issue,
Barry Goldlist