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The Worldwide Epidemic: Type II Diabetes Mellitus

Our focus this month is on diabetes and related endocrine disorders such as the metabolic syndrome. It does not take much in the way of insight to recognize that North American society is getting fatter, decade by decade. The rise in obesity and the aging of the population has resulted in a staggering increase in the prevalence of Type II Diabetes Mellitus (DMII). What surprised me this year, however, was seeing evidence of this phenomenon during my trip to China. In the prosperous urban areas of the country there are many people who are overweight. To my eye there was a clear gradient among those using different modes of transportation. Bicycle riders were more slender than drivers of electric scooters, and drivers of cars seemed to be the heaviest. In the less prosperous rural areas, everybody seemed to be quite slim. In the coming decades the absolute numbers of people with DMII in the developing world will be enormous. This epidemic will not remain a North American/Western European phenomenon.

There is an article by Dr. Jeremy Gilbert in this month’s journal entitled “Pharmacological Treatments for Diabetes Among Older Adults: An Update.” With the proliferation of new treatments for DMII this is indeed a timely topic to address, and our CME course is based on this very practical topic. However, treatment is never as desirable as prevention, and the article “Preventing Diabetes and Cardiovascular Disease in Older Adults: Controlling the Metabolic Syndrome Through Lifestyle Interventions” by Dr. Muhammad Firdaus and Dr. Timothy J. Lyons is particularly important. “Preventing Amputations in Older Adults with Diabetes” by Dr. Naven Duggal completes the trio of topics on this month’s focus.

We also have our usual collection of articles on important geriatric topics. Our cardiovascular disease column this month is “Blood Pressure and Survival in the Very Old” by Drs. Kati Juva, Sari Rastas, and Tuula Pirttilä. Our dementia topic this month is “Use of Atypical Antipsychotic Medications in Later Life” by Drs. Tarek Rajji, Benoit H. Mulsant, Hiroyuki Uchida, and David Mamo. In the past few years, real scientific evidence has started to accumulate on how to use these medications in older adults. To round off this issue, we have an informative case study by David Wan and Dr. Shabbir M.H. Alibhai entitled “A Case of Methotrexate-Induced Pancytopenia.”

Enjoy this month’s issue,

Barry Goldlist