ABSTRACT
The hallmark of diabetes is fasting and/or post-prandial hyperglycemia. Hyperglycemia results from insulin deficiency or interference with its action (insulin resistance) or both. Uncontrolled diabetes leads to widespread metabolic derangement. Sixteen million people in the United States have diabetes mellitus. The prevalence of diabetes is increasing at an alarming rate in all age groups, from children to the elderly. The disorder is progressively more common with advancing age. Fifty percent or more of the population after 80 to 90 years of age has glucose intolerance or diabetes. It is the sixth leading cause of death due to disease in the U.S. and decreases the average life expectancy up to 15 years when compared to the population without diabetes. Diabetes has an enormous social impact, mostly due to its chronic microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications. Diabetic retinopathy is the leading cause of blindness in the U.S. In people with diabetes, age 20 to 74 years, there are 12,000 to 24,000 new cases of blindness each year. Diabetic nephropathy is responsible for a large number of the patients on renal dialysis and undergoing renal transplantation. In 1996 more than 130,000 people with diabetes underwent either dialysis or kidney transplantation. Diabetic neuropathy is present in 60 to 70% of all patients with diabetes. Besides increasing the risk for sudden death and silent myocardial infarction, diabetic neuropathy leads to impotence, which is experienced by 50% of men with diabetes. Diabetic neuropathy together with peripheral vascular disease is responsible for more than 200,000 cases of foot ulcers and 80,000 limb amputations each year. Finally, diabetes is also responsible for macrovascular complications including peripheral vascular disease, stroke, and cardiovascular disease. Cardiovascular disease is the leading cause of death in diabetes (80% of all patients with diabetes die of cardiovascular disease). Seventy five percent of the cardiovascular mortality in diabetes is from coronary heart disease and 25% is from cerebral or peripheral vascular disease. Coronary heart disease, peripheral vascular disease, and stroke account for nearly one million hospital admissions each year among patients with diabetes. In women, diabetes carries yet another burden since it may lead to problems during pregnancy — mainly congenital malformations in babies born to diabetic mothers. The rate of major
tality occurs in 3 to 5% of pregnancies.
