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

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