Diagnosis and Management of Diabetes

Abstract

Diabetes mellitus represents a heterogeneous group of metabolic disorders characterized by decreased insulin secretion, insulin action, or both (Table 1). Diabetes affects over 16 million Americans, such that about 10% of the U. S. population above the age of 60 yr has diabetes, including a disproportionate number of nonwhites (1). Type 1 diabetes is characterized by autoimmune destruction of the insulin secreting pancreatic β-cells and represents <10% of all diabetes. Type 2 diabetes is the predominant disorder and is characterized by insulin resistance and a relative reduction in insulin production. It is estimated that fully half of the population with diabetes remains undiagnosed. Diabetes mellitus is associated with significant morbidity and mortality from acute complications of hypoglycemia and chronic complications including the microvascular diseases of retinopathy and nephropathy, macrovascular manifestations of coronary artery disease, myocardial infarction, and stroke, and neuropathies. As safe and effective medical therapies are available to improve metabolic control and large-scale clinical trials have demonstrated reduced complications with treatments for both types 1 and 2 diabetes, diagnostic procedures are very important.