This case study presents a 68 year old mildly obese female with known hypertension and adult onset diabetes mellitus (DM) presents to the emergency room (ER) complaining of chest pain and shortness of breath (SOB) of 3 days duration. She is currently taking digoxin, hydrochlorothiazide (HCTZ), potassium chloride (KCl), cimetidine, tolazamide for 1 year and a new analgesic nonsteroidal anti-inflammatory drug (NSAID) called "ALLPROFEN" for low back pain for the past 5 days. (Note: "ALLPROFEN" is a hypothetical new analgesic.) The patient has no known drug allergies. Her physical exam is unremarkable except for a presystolic cardiac extra sound (S4). Her blood pressure is 150/90 sitting, heart rate is 80 and regular. Lab: ECG shows LVH and nonspecific ST-T wave changes.

Cardiovascular disease (CVD) is the leading cause of death in women in the United States, accounting for nearly 30% of all deaths. Over 230,000 women die annually from acute myocardial infarction (MI), and more than 87,000 die from stroke. The incidence of coronary heart disease (CHD) increases with age in industrialized, westernized societies, and the mortality from CVD is significantly worse in women than in men.

Diabetic cystopathy is a chronic complication of diabetes with a classic triad of symptoms: decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility. This article discusses age- and diabetes-related changes that affect lower urinary tract function. The article also reviews bladder function in the older adult diabetic, explores bladder dysfunction prevention, and suggests management strategies for diabetic cystopathy. Little research has been published to date to guide practice in this area, and opportunities exist for nursing research to fill the gap in knowledge.

Older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control.

In adults age 60 years and older, DM has reached epidemic proportions in the United States, affecting 10.3 million people or 20.9% of this age group. Commencing at age 60, the lifetime risk of developing diabetes is also high: 22.4% for women and 18.9% for men. Included in these statistics are the more than 350,000 adults over age 65 who reside in long-term care facilities. Added to these numbers are the additional 6.9% of adults age 65 and older who remain undiagnosed. Because diabetes is a progressive, chronic, and highly prevalent disease in the elderly, its contribution to worsening health status and development of disabilities in older adults is significant.

Older adults with diabetes have shorter life expectancies, suffer disproportionately greater declines in physical and functional status, and have higher rates of coronary heart disease, hypertension, and stroke than their age-matched nondiabetic counterparts. This population is also at greater risk for developing one or more of the common geriatric syndromes including depression, cognitive impairment, injurious falls, polypharmacy, persistent pain, and urinary incontinence.

This video tape includes the discussion of: diabetes' demographics; pathogenesis of Type 2 diabetes; diagnosis of and screening for diabetes and impaired glucose tolerance; treatment plans; physical exams; Charcot's foot; prevalence of obesity; retinopathy; diabetes associated atherosclerotic cardiovascular disease and coronary heart disease ; intervention with nutritional therapy and exercise; treatment goals with sulfonylureas, Metformin, glucosidase inhibitors, thiazolidines and/or meglitinides.

Type 2 diabetes is associated with reduced muscle strength in older adults, according to the results of The Health, Aging, and Body Composition Study published in the June issue of Diabetes Care. "Recent studies using quantitative assessments of muscular function showed that skeletal muscle strength, especially in the lower extremity, is generally lower in adults with diabetes than in nondiabetic subjects," write Seok Won Park, MD, DrPH, from the Pochon CHA University in Korea, and colleagues. "The Health, Aging, and Body Composition Study (Health ABC) was designed to investigate the impact of changes in body composition and health conditions on age-related physiological and functional status among adults from 70 to 79 years of age.... The aim of the study was to investigate longitudinal changes of muscle mass and strength in community-dwelling older adults with and without type 2 diabetes."

Diabetes is a very common condition, especially among older adults.There are numerous benefits associated with improved glycemic control. However, achieving glycemic targets can be challenging...

Diabetes is a predictor of functional decline in older adults and is associated with increased difficulty with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This article focuses on older adults with diabetes who have disabilities associated with aging, longterm complications of diabetes such as retinopathy or neuropathy, or other comorbidities, and it outlines appropriate nursing interventions.

The purpose of this guideline is to improve the care of older persons with DM by providing a set of evidence-based recommendations that include DM-specific recommendations individualized to persons with DM who are aged 65 and older and recommendations for the screening and detection of geriatric syndromes.

These guidelines include screening; diagnosis; management of hyperlipidemic, hypertension, and hyperglycemia; nutritional management; and behavioral self-management of patients with diabetes and chronic kidney disease.

This CPG offers a systematic approach to diabetes management in the recognition, assessment, management and monitoring of type 2 diabetes in the frail, elderly nursing facility resident. The prevalence of functional disability and multiple comorbid conditions in the long term care population increases the complexity of diabetes management. This guideline recommends processes that should help LTC facilities manage and improve the care of residents with diabetes.

The ADA and AHA each have published guidelines for CVD prevention that overlap with the present statement: The ADA has issued separate recommendations for each of the cardiovascular risk factors in patients with diabetes, and the AHA has shaped primary and secondary guidelines that extend to patients with diabetes. The present document will attempt to harmonize the recommendations of both organizations where possible but will recognize areas in which ADA and AHA recommendations differ.

The National Cholesterol Education Program’s Adult Treatment Panel III report (ATP III) identified the metabolic syndrome as a multiplex risk factor for cardiovascular disease (CVD) that is deserving of more clinical attention. Subsequently, the National Heart, Lung, and Blood Institute (NHLBI), in collaboration with the American Heart Association (AHA), convened a conference to examine scientific issues related to definition of the metabolic syndrome. The present report summarizes a second conference devoted to clinical management of the metabolic syndrome, which was sponsored by the AHA in partnership with the NHLBI and cosponsored by the American Diabetes Association (ADA). This latter conference considered the following issues: (1) pathogenesis and presentation of the metabolic syndrome, (2) management of underlying risk factors, (3) management of metabolic risk factors, and (4) unresolved issues and research challenges.

The ADA defines and classifies diabetes mellitus.

This statement from the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI) is intended to provide up-to-date guidance for professionals on the diagnosis and management of the metabolic syndrome in adults.

Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.

This position statement provides evidence-based recommendations and interventions for diabetes medical nutrition therapy.

These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care.

The package inserts for both rosiglitazone and pioglitazone indicate that patients with more advanced heart disease (class III or IV) were excluded in premarketing clinical trials, and hence, these drugs are not recommended in such patients. At present, there are no guidelines on the use of thiazolidinedione (TZD) in patients with diabetes who have any degree of heart disease or for those already on a TZD who develop CHF. Because edema is a more frequent side effect of TZD therapy and by itself is often a perplexing clinical dilemma with multiple causes, clinicians may need guidance when edema (or unexpected weight gain) is encountered in a patient on a TZD. For these reasons, the American Diabetes Association and the American Heart Association assembled a workgroup to evaluate the use of TZDs in patients with preexisting heart disease and in those who develop edema or unexpected weight gain during the course of TZD therapy. This Statement is a summary of the workgroup’s findings and recommendations.

This paper is based on technical reviews titled “Diabetes Self- Management Education” and “National Standards for Diabetes Self-Management Education Programs.” To prevent or delay costly diabetes complications and to enable people with diabetes to lead healthy, productive lives, appropriate medical care based on current standards of practice, self-management education, and medication and supplies must be available to everyone with diabetes.