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September 11, 1996, Vol 276, No. 10 >
ARTICLE | September 11, 1996

A 64-Year-Old Man With Adult-Onset Diabetes FREE

Arthur H. Rubenstein, MD
[+] Author Affiliations

This conference took place at the Medicine Grand Rounds, Beth Israel Hospital, Boston, Mass, on May 9, 1996.

Reprints: Thomas L. Delbanco, MD, Division of General Medicine and Primary Care, Beth Israel Hospital, 330 Brookline Ave, LY310, Boston, MA 02215.

Clinical Crossroads at Boston's Beth Israel Hospital is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Janet Walzer, MEd, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1996;276(10):816-822. doi:10.1001/jama.1996.03540100060029
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References

Dr Delbanco:  Mr D is a 64-year-old married man who is now a media announcer after a career as a salesman. He has long-standing diabetes mellitus, first diagnosed when he was 38 years old. He has private health insurance through a managed care plan and receives ongoing care from Dr S, a general internist in a suburban community near Boston.A man who has enjoyed competitive tennis all his life, Mr D is 6 ft (180 cm) tall and has maintained a steady weight of about 178 lb (80 kg). There is a distant smoking history of about 20 pack-years; he has not smoked since 1970. He has 1 or 2 alcoholic beverages daily; there is no history of alcohol or drug abuse. He has no family history of diabetes mellitus. He continues to play tennis at least 3 times a week for 2 to 3 hours and enjoys horseback

REFERENCES

1 +
 Diabetes statistics . In: Cowie CC, Eberhardt MS, eds. American Diabetes Association's Diabetes 1996: Vital Statistics . Alexandria, Va: American Diabetes Association; 1996;:13-20.
2 +
Olefsky JM.  Insulin resistance in non-insulin-dependent diabetes mellitus . Curr Opin Endocrinol Diabetes . 1995;;2:290-299.
3 +
Lebovitz HE.  Introduction: goals of treatment . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:1-3.
4 +
Henry RR, Genuth S.  Forum one: current recommendations about intensification of metabolic control in non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):175-177.
5 +
The Diabetes Control and Complications Trial Research Group (DCCT).  The effect of intensive treatment of diabetes on the development and pro gression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;;329:304-309.
6 +
White NH.  Controversies in intensive insulin therapy . Curr Opin Endocrinol Diabetes . 1995;;2:45-50.
7 +
The Diabetes Control and Complications Trial Research Group (DCCT).  Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial . Am J Cardiol . 1995;;75:894-903.
8 +
Turner R, Cull C, Holman R, for the United Kingdom Prospective Diabetes Study 17 (UKPDS).  A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):137-145.
9 +
Laakso M.  Glycemic control and the risk for coronary heart disease in patients with non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):127-130.
10 +
Clark CM, Vinicor F, eds.  Risks and benefits of intensive management in non-insulin-dependent diabetes mellitus: the Fifth Regenstrief Conference . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):81-186.
11 +
Daly A.  Nutrition management . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:95-101.
12 +
Schneider SH.  The team approach to diabetes care . Patient Cares Clin Focus . (September) 1992;:5-9.
13 +
Horton ES.  Exercise . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:107-115.
14 +
Peters AL, Davidson MB.  Sulfonylureas in the treatment of type II diabetes . Curr Opin Endocrinol Diabetes . 1995;;2:325-332.
15 +
Lebovitz HE.  Sulfonylurea drugs . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:116-123.
16 +
Leibowitz G, Cerasi E.  Sulfonylurea treatment of NIDDM patients with cardiovascular disease: a mixed blessing? Diabetologia . 1996;;39:503-514.
17 +
 A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes, VI: supplementary report on nonfatal events in patients treated with tolbutamide . Diabetes . 1970;;25:1129-1153.
18 +
DeFronzo RA, Goodman AM, and the Multicenter Metformin Study Group.  Efficacy of metformin patients with non-insulin-dependent diabetes mellitus . N Engl J Med . 1995;;333:541-549.
19 +
Balfour JA, McTavish D.  Acarbose: an update of its pharmacology and therapeutic use in diabetes mellitus . Drugs . 1993;;46:1025-1054.
20 +
Mogensen CE.  Microalbuminuria, early blood pressure elevation, and diabetic renal disease . Curr Opin Endocrinol Diabetes . 1994;;1:239-247.
21 +
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for the Collaborative Study Group.  The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy . N Engl J Med . 1993;;329:1456-1462.
22 +
Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M.  Long-term stabilizing effect of angiotensin-converting-enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients . Ann Intern Med . 1993;;118:577-581.
23 +
 Diabetes treatment . In: Cowie CC, Eberhardt MS, eds. American Diabetes Association's Diabetes 1996: Vital Statistics . Alexandria, Va: American Diabetes Association; 1996;:71-74.
24 +
The Diabetes Control and Complications Trial Research Group.  Influence of intensive diabetes treatment on quality-of-life outcomes in the Diabetes Control and Complications Trial . Diabetes Care . 1996;;19:195-203.
25 +
Testa MA, Simonson DC. Beneficial effects of improved glycemic control with glipizide GITS on quality of life and symptom distress in NIDDM. In: Program and abstracts of the 56th Annual Meeting and Scientific Sessions of the American Diabetes Association; June 8-11, 1996; San Francisco, Calif. Abstract 450.
26 +
Saltiel AR, Horikoshi H.  Thiazolidinediones are novel insulin-sensitizing agents . Curr Opin Endocrinol Diabetes . 1995;;2:341-347.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Diabetes statistics . In: Cowie CC, Eberhardt MS, eds. American Diabetes Association's Diabetes 1996: Vital Statistics . Alexandria, Va: American Diabetes Association; 1996;:13-20.
2 +
Olefsky JM.  Insulin resistance in non-insulin-dependent diabetes mellitus . Curr Opin Endocrinol Diabetes . 1995;;2:290-299.
3 +
Lebovitz HE.  Introduction: goals of treatment . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:1-3.
4 +
Henry RR, Genuth S.  Forum one: current recommendations about intensification of metabolic control in non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):175-177.
5 +
The Diabetes Control and Complications Trial Research Group (DCCT).  The effect of intensive treatment of diabetes on the development and pro gression of long-term complications in insulin-dependent diabetes mellitus . N Engl J Med . 1993;;329:304-309.
6 +
White NH.  Controversies in intensive insulin therapy . Curr Opin Endocrinol Diabetes . 1995;;2:45-50.
7 +
The Diabetes Control and Complications Trial Research Group (DCCT).  Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial . Am J Cardiol . 1995;;75:894-903.
8 +
Turner R, Cull C, Holman R, for the United Kingdom Prospective Diabetes Study 17 (UKPDS).  A 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):137-145.
9 +
Laakso M.  Glycemic control and the risk for coronary heart disease in patients with non-insulin-dependent diabetes mellitus . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):127-130.
10 +
Clark CM, Vinicor F, eds.  Risks and benefits of intensive management in non-insulin-dependent diabetes mellitus: the Fifth Regenstrief Conference . Ann Intern Med . 1996;;124( (suppl 1) , pt 2):81-186.
11 +
Daly A.  Nutrition management . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:95-101.
12 +
Schneider SH.  The team approach to diabetes care . Patient Cares Clin Focus . (September) 1992;:5-9.
13 +
Horton ES.  Exercise . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:107-115.
14 +
Peters AL, Davidson MB.  Sulfonylureas in the treatment of type II diabetes . Curr Opin Endocrinol Diabetes . 1995;;2:325-332.
15 +
Lebovitz HE.  Sulfonylurea drugs . In: Lebovitz HE, ed. American Diabetes Association Clinical Education Series' Therapy for Diabetes Mellitus and Related Disorders . 2nd ed. Alexandria, Va: American Diabetes Association; 1994;:116-123.
16 +
Leibowitz G, Cerasi E.  Sulfonylurea treatment of NIDDM patients with cardiovascular disease: a mixed blessing? Diabetologia . 1996;;39:503-514.
17 +
 A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes, VI: supplementary report on nonfatal events in patients treated with tolbutamide . Diabetes . 1970;;25:1129-1153.
18 +
DeFronzo RA, Goodman AM, and the Multicenter Metformin Study Group.  Efficacy of metformin patients with non-insulin-dependent diabetes mellitus . N Engl J Med . 1995;;333:541-549.
19 +
Balfour JA, McTavish D.  Acarbose: an update of its pharmacology and therapeutic use in diabetes mellitus . Drugs . 1993;;46:1025-1054.
20 +
Mogensen CE.  Microalbuminuria, early blood pressure elevation, and diabetic renal disease . Curr Opin Endocrinol Diabetes . 1994;;1:239-247.
21 +
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD, for the Collaborative Study Group.  The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy . N Engl J Med . 1993;;329:1456-1462.
22 +
Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M.  Long-term stabilizing effect of angiotensin-converting-enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients . Ann Intern Med . 1993;;118:577-581.
23 +
 Diabetes treatment . In: Cowie CC, Eberhardt MS, eds. American Diabetes Association's Diabetes 1996: Vital Statistics . Alexandria, Va: American Diabetes Association; 1996;:71-74.
24 +
The Diabetes Control and Complications Trial Research Group.  Influence of intensive diabetes treatment on quality-of-life outcomes in the Diabetes Control and Complications Trial . Diabetes Care . 1996;;19:195-203.
25 +
Testa MA, Simonson DC. Beneficial effects of improved glycemic control with glipizide GITS on quality of life and symptom distress in NIDDM. In: Program and abstracts of the 56th Annual Meeting and Scientific Sessions of the American Diabetes Association; June 8-11, 1996; San Francisco, Calif. Abstract 450.
26 +
Saltiel AR, Horikoshi H.  Thiazolidinediones are novel insulin-sensitizing agents . Curr Opin Endocrinol Diabetes . 1995;;2:341-347.

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