Epidemiology, costs, consequences, and pathophysiology of type 2 diabetes: an american epidemic.

The prevalence of diabetes in the United States increased by 33% from 4.9% in 1990 to 6.5% in 1998. Presently almost 16 million Americans have diabetes mellitus, and the prevalence of diabetes is doubling every 10-15 years. More than 90% of diabetic patients have type 2 diabetes; about one third of patients with type 2 diabetes are not yet diagnosed. Diabetes is the number one cause of adult blindness, end-stage renal disease, and nontraumatic amputations in the US and is associated with a marked increase in atherosclerotic disease.Diabetes is one of the most costly of medical conditions. In the US, 1 in every 7 health care dollars and 25% of the Medicare budget is spent on patients with diabetes. In 1997, total direct and indirect costs attributed to diabetes in the US were estimated at $98 billion. Substantial data suggest that glycemic control reduces morbidity and mortality as well as health care costs and improves quality of life and productivity.Relatively new diagnostic criteria for diabetes lower the threshold for diagnosis from 140 to 126 mg/dL. The pathophysiology of type 2 diabetes must be considered in the formulation of treatment strategies. The majority of patients with type 2 diabetes have both insulin resistance and an insulin secretory deficit. While medical nutrition therapy and carefully prescribed exercise remain the cornerstones of treatment, most patients will require pharmacologic agents to achieve treatment goals. In fact, studies indicate that most patients will require combinations of antidiabetic agents with complementary mechanisms of action. Fortunately, many new antidiabetic agents available during the past several years provide more options for patients with type 2 diabetes.