ABSTRACT
INTRODUCTION Diabetes is one of the most common chronic diseases with increased cardiovascular morbidity and mortality [1]. About 150 million worldwide are suffering from this condition and the number is expected to rise to 300 million by 2025. In the United States, more than 17 million people suffer from diabetes [2]. Among those older than 25 years of age, 450,000 Americans (or 19% of all deaths) died from its related complications in 1999, with cardiovascular disease and stroke accounting for approximately two-thirds of the deaths. Overall, diabetes is the sixth most common cause of death, with an age-adjusted mortality rate of 18.5 per 100,000 Americans in 1996. This figure is almost three-fold greater than deaths attributed to Human Immuno-deficiency Virus infection (HIV). Not unexpectedly, the total cost burden for this condition was estimated to be $132 billion in 2002, with about a third of the expenditure attributed to indirect cost such as temporary or permanent disability, and premature death [3]. Of the remaining $92 billion used for direct medical costs, approximately a fifth was employed for management of cardiovascular complications. In fact, the annual medical expenditure for a patient with diabetes was estimated to be 2.4 times higher than a nondiabetic. With a million new patients diagnosed with diabetes each year in the United States, the strain on financial and medical resources will continue to increase to an estimated amount of $192 billion by 2020.
