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A letter to the editor is presented in response to the article "Improving the care of elderly diabetic patients: the final report of the St. Vincent Joint Task Force for Diabetes" published in a 1997 issue.

Abstract: Authors have considered the prevalence of hypertension (HT), myocardial infarction (MI) and stroke (S), in elderly subjects with diabetes, impaired fasting glucose (IFG) and normal fasting glucose (NFG), respectively. A high occurrence of diabetes in elderly subjects has been found. MI and S were more frequent in diabetic group than in IFG and NFG ones. HT proved to be elevated in the total pool, especially in older olds, and with a higher prevalence among those with diabetes. A 5-year follow-up has been carried out. The index of survival for MI and S was lower in subjects with diabetes. The subjects affected by both MI and S displayed the worst index of survival in all the three categories considered, therefore, it can be stated that such an association is a determinant factor of mortality. [Copyright &y& Elsevier]

The aging of population has been characteristic for the industrial countries during the last years. It is essentially due to two factors: the increase of life span and the decrease of births. Today the health conditions of the older population are better than in the past, but in octagenarians morbidity and disability globally increased. Therefore, aging of the population involves also more expenses for all the health care services, i.e., both for each older patient’s family, and for the community. In departments of geriatric medicine it is right to consider two kinds of patients: older patient and geriatric patient. Multidimensional assessment and global intervention performed by a multidisciplinary team can obtain much better results for the geriatric patients, than the traditional medical strategies. Several reviews show also that departments of geriatric medicine achieve better results, than of the common internal medicine. Geriatric medicine departments have different aspects not only in the treatment of diseases, but also in supporting a global assistance, which aim also at rehabilitating the patient. Because of this central role and indispensability of the geriatric specialists, their work in the network of services should be obligatory, since only a continuous and global care can guarantee significant results for the geriatric patients. [Copyright &y& Elsevier]

Background: The inverse relationship of insulin level to high-density lipoprotein (HDL)-cholesterol and its positive association with hypertriglyceridemia has been demonstrated in several studies; however, the relationship of insulin to low-density lipoprotein (LDL)-cholesterol in elderly persons is not clear. This study investigates the relationships of fasting plasma insulin and selected metabolic and biological risk factors in an aged population.Methods: The present study is based on a cross-sectional analysis of the data collected at baseline of the Italian Longitudinal Study on Aging in 1992 on a random sample of 5632 Italians aged 65-84 years. Analyses were performed to compare the distribution of risk factors, such as blood level of lipids, creatinine, albumin, fibrinogen, apolipoprotein A-1 and B, blood pressure, and body mass index (BMI), by quartiles of insulin, in both diabetic and nondiabetic participants.Results: Significantly higher levels of triglycerides and BMI and lower levels of HDL-cholesterol were found in the upper quartile of insulin among nondiabetic individuals. In men, we also found significantly higher levels of systolic and diastolic blood pressure. The same trend for these variables, although not significant for HDL-cholesterol and blood pressure, was seen in diabetic men. In diabetic women, total and LDL-cholesterol were significantly lower in the highest insulin quartile (p <.001), while no significant differences were seen in nondiabetic women or in men. We also found higher levels of white blood cells in the highest insulin quartile of diabetic women.Conclusions: These results, apparently in disagreement with earlier reports on the clustering of cardiovascular disease risk factors in hyperinsulinemic individuals, could be due to the high frequency of chronic inflammation and the high prevalence of urinary infections in older diabetic women. [ABSTRACT FROM AUTHOR]