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Screening and Management of Diabetic Microvascular Complications in Older Adults

Amish Parikh, MD and I. George Fantus, MD, FRCPC, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON.

Microvascular complications of both Type 1 and Type 2 diabetes mellitus (DM) can be classified into three major categories: retinopathy, nephropathy and neuropathy. Numerous studies have consistently shown that the development of complications in both Type 1 and Type 2 diabetes is related to several factors. The most important ones, however, include glycemic control (as measured by hemoglobin A1c) and the duration of diabetes. This article reviews the details of screening and management of diabetic microvascular complications in older adults. It incorporates guidelines from both the Canadian and American Diabetes Associations, as well as reviews of recently published literature.
Key words: diabetes mellitus, retinopathy, nephropathy, neuropathy, screening, management.

Related Terms: Diabetes-Endocrine Disorders, diabetes mellitus, management, nephropathy, neuropathy, retinopathy, screening

Strategies for the Management of Hypertension in the Diabetic Patient

David H. Fitchett MD, FRCP(C), St Michael's Hospital, University of Toronto, Toronto, ON.

For the diabetic patient, hypertension more than doubles the risk of myocardial infarction, stroke and cardiovascular death, and is central in the development of diabetic nephropathy. Control of hypertension is an important vascular protective measure. However, the thresholds and goals of antihypertensive treatment have fallen as trials have shown improved outcomes with blood pressures reduced to 120/80mmHg or less. Although reducing blood pressure to the lower target levels must be the primary goal of treatment, the use of diuretics and angiotensin-converting enzyme inhibitors should be considered as first-line therapy in the diabetic patient. Both agents have been demonstrated to improve a wide range of cardiovascular outcomes compared to other antihypertensive medications.
Key words: diabetes, hypertension, nephropathy, blood pressure control.

Related Terms: Cardio-Cerebrovascular, Diabetes-Endocrine Disorders, blood pressure control, diabetes, hypertension, nephropathy
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