Older people diabetes mellitus

Metabolic disorders are common, especially diabetes mellitus, a disorder of the glucose control. Most serious is type 1 diabetes, where the beta cells are destructed, typically by an autoimmune reaction, so the patient must be given insulin the rest of his/her life. Untreated it can lead to death within some months to a few years. It attacks mainly younger adults or children. The second, called type 2 diabetes, affects older people, typically in their 60s and typically obese. The disease is a combination of a decreased insulin production and an impaired glucose disposal. It evolves slowly and many patients can, at least in the beginning, be controlled with diet and exercise. 

In the adult population, the prevalence of overt hypothyroidism is 19 per 1000 women and 1 per 1000 men with annual incidence of overt hypothyroidism is 4 per 1000 women and 0.6 per 1000 men. Subclinical hypothyroidism is also more common in women, the incidence increases with age, with up to 10% of women older than 60 years having an increased thyroid-stimulating hormone concentration. Subclinical hypothyroidism is more common in people who have been treated for hyperthyroidism with radioactive iodine or surgery, and in those with organ-specific autoimmune diseases, such as pernicious anaemia, type 1 diabetes mellitus, or Addison s disease. 

Type 2, also known previously as non-insulin-dependent diabetes mellitus (NIDDM), accounts for 90 to 95 percent of persons with diabetes mellitus.19 This form of diabetes usually occurs in adults, especially in older individuals.35,102 Type 2 diabetes, however, can also occur in young people, and there is concern that the incidence of this disease is increasing dramatically in children and adolescents.9,83 Although the specific factors responsible for this disease are unknown, a genetic predisposition combined with poor diet, obesity, and lack of exercise all seem to contribute to the onset of type 2 diabetes.50,81,83 Increased body weight is common in patients with type 2 diabetes. 

Type 2 (formerly, non-insulin dependom diabetes mellitus, NIDDM), which typic.illy occurs in older, often obese people who retain capacity to secrete insulin but who arc resistant to its. action.Those terms and abbreviations are used in this ciiaptei. ... 

Diabetes is a worldwide problem afflicting approximately 5% of the adult population of industrialized nations. In the USA 18.2 million people (13 million diagnosed, 5.2 million undiagnosed), approximately 6% of the US population is afflicted with diabetes. Over 40% of the population with diabetes is age 60 or older and 90-95% of all diagnosed cases of diabetes are type II diabetes (non-insulin dependent diabetes mellitus or adult-onset diabetes) [28]. There is a great need to develop the best possible glucose biosensors to continuously, accurately, painlessly and safely monitor blood glucose level to improve the lives of all diabetics. 

Centers for Disease Control and Prevention (CDC), which estimated a prevalence in 2001 of 7.9% in adults. This is equivalent to 16.7 million people. Because at least 30% of all prevalent cases are undiagnosed, the total number may have been almost 22 million. Note that in 1987, the prevalence of diagnosed diabetes was 6.8 million. This large increase in diabetes has been observed globally. The prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and anticipated to rise to 5.4% by the year 2025. The prediction is that in 2025 there will be 300 million adults with diabetes, greater than 75% of whom will live in developing countries. These statistics have led to diabetes being described as one of the main threats to human health in the twenty-first century. The prevalence of diabetes mellitus increases with age, and approximately half of all cases occur in people older than 55 years. In the United States, -20% of the population older than 65 years have diabetes. There is racial predilection, and by the age of 65, 33%, 25%, and 17% of Hispanics, blacks, and whites, respectively, in the United States have diabetes mellitus. In 2002 diabetes mellitus was estimated to be responsible for 132 billion in healthcare expenditures in the United States. The direct costs were 92 billion, with 50% of that incurred by those older than 65 years. An estimated 186,000 deaths annually are attributable to diabetes. In fact, American women are twice as likely to die from diabetes mellitus as from breast cancer. Approximately one in five American healthcare dollars spent in 2002 was for people with diabetes mellitus. 

The standards issue becomes most problematic with patients who have multiple problems. It may be sensible to delay the treatment of pneumonia, for instance, while more urgent investigations and treatments are instituted. An additional problem is that of combining multiple treatments with the risk of adverse drug events and actually producing harm through the application of standard procedures. Wachter (2006) has argued that quality measurement is bewildered by the patient with multiple conditions, which is, of course, most people admitted to hospital and many older people outside hospital. He considers a hypothetical 79-year-old woman with five common diseases hypertension, osteoporosis, osteoarthritis, type 2 diabetes mellitus and chronic obstructive pulmonary disease ... 

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