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Aging in Westernized industrialized societies is associated with an increasing prevalence of hypertension, type II diabetes mellitus, renal disease, and atherosclerotic vascular disease. This increase in the chronic disease processes in industrialized societies is related, in part, to increasing obesity, reduced physical activity, medications such as nonsteroidal anti-inflammatory agents, and other environmental influences. Hypertension in the elderly is characterized by high peripheral vascular resistance, reduced baroreflex sensitivity, a low renin state with reduced cardiac output/increased hypertrophy, reduced intravascular volume, and an increased propensity to salt-sensitivity. Initial antihypertensive therapy in the elderly patient should be based on attempts to affect hygienic measures such as weight reduction, decreased salt and fat intake, and a careful aerobic exercise program. The initial antihypertensive drugs of choice are low doses of diuretics, which have been shown to reduce cardiovascular mortality in the elderly. Low doses of diuretics do not substantively affect carbohydrate and lipid metabolism. Lipid abnormalities in the elderly should generally be treated in a similar fashion to those in the middle-aged individual. Compliance with medical therapy in the elderly patient has been demonstrated to be relatively good.
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PMID:Treatment of Elderly Hypertensive Patients With Diabetes, Renal Disease, and Coronary Heart Disease. 1141 94

Type 2 diabetes is a common chronic disease affecting more than 100 millions of people world-wide, and is a major cause of premature morbidity and mortality. Macrovascular disease and its risk factors are often already present in individuals at risk for type 2 diabetes, and some of the risk factors for the development of type 2 diabetes, such as obesity, physical inactivity, and high-fat diet, can potentially be modified. Because some of the metabolic abnormalities, such as insulin resistance or impaired glucose tolerance, that indicate a risk for diabetes can be improved by lifestyle modification and drug treatment, strategies for the prevention of type 2 diabetes appear to be necessary for affected individuals. Several clinical trials have addressed the hypothesis that type 2 diabetes can be prevented by dietary modification, physical activity, or drug treatment. Although some of these studies indicate a protective effect of these measures against the development of type 2 diabetes in people at risk, many of their conclusions are limited with respect to randomisation, sample size, or intensity of the intervention. In the large prospective Da Qing study (1997), both dietary and physical activity interventions reduced the incidence of type 2 diabetes considerably in a Chinese population. Whether this is also achievable in other ethnic populations at high risk for developing type 2 diabetes, and whether additional pharmacological measures are useful, is currently under investigation.
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PMID:Strategies for the prevention of type 2 diabetes. 1146 May 74

Obesity is a chronic disease and requires ongoing treatment. Type 2 diabetes is associated with obesity and improves with weight loss. Diets of 800 kcal/d induce twice the weight loss induced by weight loss medications. The strength of weight loss medication, which should be used with diet and a lifestyle change program, is the maintenance of weight loss. Sibutramine and orlistat are the only two medications approved for the long-term treatment of obesity. Orlistat gives a reduction of low-density lipoprotein (LDL) cholesterol in excess of that expected with weight loss, and the drop in blood pressure expected with weight loss is not seen with sibutramine. Except in newly diagnosed patients with diabetes subjects, patients with diabetes lose half the weight of subjects who do not have diabetes when treated with weight loss medications. Metformin and, to a lesser extent, acarbose cause weight loss, making them attractive choices for the treatment of obese type 2 diabetic subjects. Repaglinide appears to be weight-neutral, but other medications for patients with diabetes can be associated with weight gain. Many new medications are in development for the treatment of obesity. These new medications act through a variety of mechanisms and will surely play an increasingly important role in the treatment of obese patients with type 2 diabetes.
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PMID:Obesity medications and the treatment of type 2 diabetes. 1147 74

The number of individuals aged 60 y or older is projected to double as a proportion of the world's population and to more than triple in number over the next 50 y. These changes will be most dramatic in the less developed countries, where the transition from a young to old age structure will be more compressed in time than it has been for developed countries. At the same time, there is evidence of a characteristic sequence of changes in diet and declines in physical activity associated with social and economic change. Diets are becoming higher in fats, animal products, and refined foods and lower in fiber, contributing to rapidly increasing prevalences of obesity and type 2 diabetes. The number of people with diabetes in developing countries is projected to almost triple by the year 2025. Hypertension and vascular disease are also rapidly becoming more prevalent. Evidence that lower birth weights are associated with greater likelihood of adult obesity and chronic disease underscores the magnitude of risk in these countries. Few programs or institutions currently exist to address the problems of the growing elderly population. The social changes that accompany urbanization will likely increase nutritional risk for this group. Despite lower energy intakes with age, elderly have higher requirements for several micronutrients, making them vulnerable to deficiencies that further aggravate chronic conditions. To reduce the impending burden of disease and disability worldwide, urgent action is needed to understand and to address the nutritional needs of the aging population.
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PMID:Nutrition and aging in developing countries. 1153 87

Many genetic, environmental, behavioral, and cultural factors affect health. Diet is as vital as any of them for preventing disease and promoting well-being. We know that what we eat can lead to premature disability and mortality: to obesity, coronary heart disease, type 2 diabetes, degenerative arthritis, sleep apnea, and other illnesses. Now scientific evidence points to links between dietary patterns and illness. The study of these links is a new approach to understanding the role that diet plays in chronic disease. Initial studies include those on eating patterns and risk of colon cancer. More recently, researchers have investigated all-cause mortality and leading causes of chronic disease. Novel epidemiological approaches include factorial analysis to evaluate dietary patterns and cluster analysis to examine nutrient intake, gender, and weight status across food-pattern clusters. These methods work best within groups to identify major dietary patterns, but not necessarily ideal diets. They may also differ across population groups. The success of the Dietary Approaches to Stop Hypertension and Lyon Diet Heart studies supports the value of dietary pattern analysis. At the same time, the relative failure of single-nutrient studies underscores the need for new methodologies and directions in research.
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PMID:Treatment approaches: food first for weight management and health. 1170 45

Type 2 diabetes is a common, chronic disease, with a high risk of macrovascular and microvascular complications that lead to premature death and disability. The disease is managed largely in primary care and its rising prevalence will increase the workload of community nurses. The forthcoming Diabetes National Service Framework will aim to improve the standards of diabetic care, while scientific and technological developments offer new treatments that may also improve the outlook for patients. There is as yet no case for population screening for type 2 diabetes, but community nurses are ideally placed to carry out local screening initiatives based on consensus guidelines.
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PMID:Recent developments in the management of type 2 diabetes. 1182 24

Diabetes Mellitus is a chronic disease well known for its fatal complications. Therefore, an international call for measures was declared to keep complications of diabetes to a minimum in order to reduce the costs of treating these complications (St. Vincent Declaration). The common international guidelines for treatment of patients with Type 1 Diabetes Mellitus are the Diabetes Control and Complications Trial (DCCT). The United Kingdom Prospective Diabetes Study (UKPDS) investigated the use of tight glycaemic control in those with Type 2 Diabetes Mellitus. This paper will explain the importance of intensive insulin treatment for diabetic patients, even when they are dialysing, to prevent diabetic complications. There's always a possibility of reducing diabetic complications to ensure a better quality of life. It will also discuss the different treatment options available including Continuous Subcutaneous Insulin Infusion, which has been demonstrated as the most effective mode of treatment.
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PMID:Education of patients and use of insulin pumps in diabetic treatment. 1190 36

This article introduces a new theory of geographical analysis, sociospatial knowledge networks, for examining and understanding the spatial aspects of health knowledge (i.e., exactly where health beliefs and knowledge coincide with other support in the community). We present an overview of the theory of sociospatial knowledge networks and an example of how it is being used to guide an ongoing ethnographic study of health beliefs, knowledge, and knowledge networks in a rural community of African Americans, Latinos, and European Americans at high risk for, but not diagnosed with, type 2 diabetes mellitus. We believe that the geographical approach to understanding health beliefs and knowledge and how people acquire health information presented here is one that could serve other communities and community health practitioners working to improve chronic disease outcomes in diverse local environments.
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PMID:Sociospatial knowledge networks: appraising community as place. 1193 9

Obesity is a chronic disease so that results of obesity treatment should only be evaluated on a long-term basis. The present paper aims at analyzing the long-term (1 year or more) results of three anti-obesity approaches, i.e. lifestyle modifications, pharmacological treatments and surgical procedures. Dietary interventions include diets with moderate calorie restriction and very-low energy diets (VLED). Even if an initial greater weight loss is observed with VLED, no study has conclusively shown that the long-term approaches including VLED are better than non-VLED programmes. Physical activity is not the most efficient method of initial weight loss, but it appears to be more crucial for maintaining weight loss once it has occurred. In general, long-term results of lifestyle modifications are disappointing because of poor compliance. Several 1-2 year large-scale randomized placebo-controlled clinical trials with orlistat, an intestinal lipase inhibitor, and sibutramine, a central appetite regulator, have demonstrated that both drugs significantly, although modestly on average, increase weight reduction, almost double the number of responders (weight loss >=5 or 10% of initial body weight) and improve weight maintenance up to 2 years. Surgical procedures provide a much greater weight reduction than medical interventions in patients with morbid obesity, particularly after a follow-up of several years. Weight loss is greater with gastric bypass, inducing some malbsorption, than with gastroplasty, a pure gastric restriction technique. Associated risk factors such as markers of insulin resistance syndrome and type 2 diabetes are remarkably reduced, but no prospective study of morbidity or mortality is available yet. In all cases, the management of obesity requires a multidisciplinary approach to improve the success rate.
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PMID:Results of obesity treatment. 1199 82

Increasingly, type 2 diabetes takes a toll on public health and healthcare costs in the United States. Although the remedy for this growing problem is very complex, two critical components of its control are prevention and effective therapy. Progress in diabetes prevention is likely to take decades. But fortunately, growth in our understanding of what occurs in this chronic disease has led to advances in the pharmacologic options aimed at decreasing hyperglycemia, the main clinically measurable metabolic consequence of diabetes. In this article, Drs Ahmann and Riddle provide an overview of the oral agents now available for the treatment of diabetes and discuss the clinical factors that help determine when to use which medication and what outcome to expect.
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PMID:Current oral agents for type 2 diabetes. Many options, but which to choose when? 1204 Aug 62


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