With an increasing incidence worldwide, DM will be a leading cause of morbidity and mortality for the foreseeable future.
DM1 is classified on the basis of the pathogenic process that leads to hyperglycemia, as opposed to earlier criteria such as age of onset or type of therapy. The two broad categories of DM are designated type 1 and type 2. Type 1A DM results from autoimmune beta cell destruction, which leads to insulin deficiency. Individuals with type 1B DM lack immunologic markers indicative of an autoimmune destructive process of the beta cells. However, they develop insulin deficiency by unknown mechanisms and are ketosis prone. Relatively few patients with type 1 DM are in the type 1B idiopathic category; many of these individuals are either African-American or Asian in heritage.
Type 2 DM1 is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production. Distinct genetic and metabolic defects in insulin action and/or secretion give rise to the common phenotype of hyperglycemia in type 2 DM. ...
Likewise, prevalence rates of IFG3 are also increasing. Although the prevalence of both type 1 and type 2 DM is increasing worldwide, the prevalence of type 2 DM is expected to rise more rapidly in the future because of increasing obesity and reduced activity levels. DM increases with aging. In 2000, the prevalence of DM was estimated to be 0.19% in people 20 years old. In individuals >65 years the prevalence of DM was 20.1%. The prevalence is similar in men and women throughout most age ranges but is slightly greater in men >60 years.
The prevalence of type 2 DM and its harbinger, IGT2, is highest in certain Pacific islands, intermediate in countries such as India and the United States, and relatively low in Russia and China. This variability is likely due to genetic, behavioral, and environmental factors. DM prevalence also varies among different ethnic populations within a given country. In 2000, the prevalence of DM in the United States was 13% in African Americans, 10.2% in Hispanic Americans, 15.5% in Native Americans (American Indians and Alaska natives), and 7.8% in non-Hispanic whites. The onset of type 2 DM occurs, on average, at an earlier age in ethnic groups other than non-Hispanic whites.
Mortality rates in people with diabetes exceed those in the general population despite many recent improvements in care. Diabetes is one of the most common chronic diseases in the young, and is a substantial cause of morbidity as well as mortality at all ages. After the introduction of insulin in 1922 it was hoped that adverse consequences of diabetes might become a thing of the past, but mortality rates are still higher than those in the general population and, in addition,