Harris M I
National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892, USA.
Diabetes Care. 1998 Dec;21 Suppl 3:C11-4. doi: 10.2337/diacare.21.3.c11.
Epidemiological studies performed over the past 40 years have shown that the prevalence of diagnosed diabetes has increased dramatically in the U.S. and that a substantial proportion of the population has undiagnosed diabetes, impaired fasting glucose, and impaired glucose tolerance. Diabetes is most prevalent in minority populations, such as African-Americans, Native Americans, and Mexican Americans. Increasing prevalence of diabetes has led to increases in microvascular complications such as blindness, end-stage renal disease, and lower limb amputations. Poor glycemic control contributes to the high incidence of these complications, yet community-based studies of diabetic patients show their mean fasting plasma glucose concentration is generally > 180 mg/dl compared with 100 mg/dl for nondiabetic individuals. In people with diabetes, risk factors for cardiovascular disease including elevated fasting plasma glucose, blood pressure, total cholesterol, triglycerides, and obesity partly explain the high proportion of deaths (60-70%) caused by cardiovascular disease in people with diabetes. More intensive diabetes management and improved glycemic control could minimize long-term complications of the disease and would be expected to reduce the morbidity, mortality, and costs associated with diabetes.
过去40年进行的流行病学研究表明，美国确诊糖尿病的患病率急剧上升，而且相当一部分人口患有未确诊的糖尿病、空腹血糖受损和糖耐量受损。糖尿病在少数族裔人群中最为普遍，如非裔美国人、美国原住民和墨西哥裔美国人。糖尿病患病率的上升导致了微血管并发症的增加，如失明、终末期肾病和下肢截肢。血糖控制不佳导致了这些并发症的高发病率，但对糖尿病患者的社区研究表明，他们的平均空腹血糖浓度通常>180mg/dl，而非糖尿病个体为100mg/dl。在糖尿病患者中，心血管疾病的危险因素包括空腹血糖升高、血压、总胆固醇、甘油三酯和肥胖，这在一定程度上解释了糖尿病患者中由心血管疾病导致的高死亡比例（60-70%）。更强化的糖尿病管理和改善血糖控制可以将该疾病的长期并发症降至最低，并有望降低与糖尿病相关的发病率、死亡率和成本。
