Diabetes Mellitus: The Medical Challenge of Modern Times

When I started medical school, the era of syphilis as a major scourge of medicine had already ended. Because of its protean manifestations, it was once said that the doctor who knew syphilis, knew medicine. While I doubt if thoroughly knowing any single disease could ever qualify a person as "knowing medicine," diabetes mellitus might be the disease that comes closest. From head (eye complications) to toe (foot ulcers), it seems that virtually every major body system and anatomical area can be affected by diabetes mellitus. As well, Type II diabetes mellitus gives us an excellent example of how "nature and nurture" interact in chronic disease. Even with the appropriate genotype for the disease, a person who remains fit and lean can often avoid the clinical manifestations of the illness.
In this month's journal, we focus on diabetes management. Over the past few years, new forms of insulin, new oral agents, and a new understanding of the use of oral agents in association with insulin have transformed the glycemic management of diabetes mellitus. Dr. Daniel Tessier, an expert in diabetes mellitus in the older adult, summarizes current practice in his article "Stepwise Approach to the Treatment of Diabetes in the Older Adult." Dr. Shobha Rao reviews the "Diagnosis and Management of Impaired Glucose Tolerance and Impaired Fasting Glucose." Current management of diabetes mellitus might start with glucose control, but it is doomed to failure if other cardiac risk factors are not addressed concurrently. Drs. Raymond Fung and Lorraine Lipscombe contribute the article "Treating Dyslipidemia and Hypertension in the Older Person with Diabetes: An Evidence-Based Review." We have two articles on the complex and challenging task of managing diabetic foot ulcers. Drs. Madhuri Reddy (geriatrician and Associate Editor of Geriatrics & Aging) and Gary Sibbald (dermatologist) have contributed an article entitled "Management of Diabetic Foot Ulcers," while Oksana Davidovich (chiropodist) provides a complementary article on "Promoting Healing in Diabetic Foot Ulcers."
As well, we have our usual assortment of articles pertaining to the care of older adults. Dr. David Fitchett provides the article "ABCs of Prescribing Antianginal Therapy in Chronic Stable Angina." Drs. Alan Bell and Douglas Conway have written the article "Management of the At-Risk Patient with Osteoarthritis." This is particularly relevant given the recent controversies concerning COX-2 inhibitors. Marcia Zalev and Penny Pashby, two social workers with extensive experience in managing patients with dementia, have written the article "Using the C.A.R.E Approach: Supporting Family Caregivers of Dementia Patients." It also serves as an important reminder that management of patients with dementia requires much more than just the provision of effective medications. We continue the publication of evidence-based material with the article "Translating Evidence into Clinical Practice: A Falls Prevention Program for Community Dwelling Seniors" by Susan Maddock, Susan Gal, MaryJane McIntyre, Rory Fisher, and Barbara Liu. Those who read this journal regularly know how excited I am about the topic of falls prevention, and how important I feel widespread community programs are for this issue, so I thank our editorial staff for
publishing this article! Dr. D'Arcy Little, Medical Director for CME, provides conference coverage with an article entitled "Psychogeriatric Update 2004: Late-Life Mood Disorders." Finally, Dr. Mark Clarfield provides a diversion in his article, "Medical Meanings."

Enjoy this issue,
Barry Goldlist