Diabetes: Magnitude and Mechanisms

The scope of medical practice changes as diseases, therapies, and prognoses are constantly shifting. One major source of change in the field of health care is in the treatment of diabetes, which is consuming an increasingly large portion of national health care expenditures and effort. Diabetes is, in many ways, a large part of the future of medicine in the United States and in many parts of the world. Understanding and excelling in the treatment of diabetes, therefore, is an increasingly important aspect of a successful career in medicine. Over the next 3 years, Clinical Diabetes will devote a section of each issue to reviewing the fundamentals of diabetes care for physicians-in-training. The goal is to provide doctors in internships and residency programs with important information regarding diabetes and the care of patients who have it. We intend to focus on salient, practical information that can be rapidly used in the clinical setting. We begin by highlighting the scope of diabetes and key pathophysiological attributes of the four common types of diabetes.

Diabetes has become a major cause of morbidity and mortality in the United States and is increasing in the rest of the world. Seemingly everywhere, the prevalence of diabetes has increased steadily over the past several decades. The Centers for Disease Control and Prevention estimates that the crude prevalence of diabetes has increased 104% from 1980 through 2004, although changes in the definition of diabetes may have affected that number.¹ This information is based on the National Health and Nutrition Examination Survey (NHANES), which has studied the population during several decades.

Recently, NHANES became a continuous program and reported its results from the 1999-2002 data collection period. During that time period, > 4,000 adults throughout the United States were surveyed and screened for diabetes. The study …