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A search for specific references and reviews was conducted in PubMed. Diabetes Care provides a use for search for position papers and clinical practice guidelines and can be accessed at


An epidemic of diabetes mellitus is sweeping the United States and the developing world. Since 1958, the prevalence of diabetes has increased more than 5-fold. Between 1991 and 2001, the prevalence of diabetes has increased by 49% overall, by 76% in the 30 to 39 age group, and as much as 10-fold in the pediatric population. As the population ages and becomes more overweight, the two major risk factors for type 2 diabetes, the epidemic of diabetes continues to accelerate. The cost of this disease for our society is shocking. Diabetes accounts for 15% of health care costs and 25% of Medicare costs in the United States. The total expenditure of our society on diabetes is greater than any other disease entity, including heart disease, cerebrovascular disease, cancer, and HIV. Most of this cost is from preventable complications of diabetes.1


Diabetes is a risk equivalent for cardiovascular disease (CVD) and is the leading cause of renal failure, adult blindness, and nontraumatic limb amputation in the United States. The Diabetes Control and Complications Trial showed significant risk reduction in the development of cardiovascular events, retinopathy, nephropathy, and neuropathy in patients with Type 1 diabetes mellitus with more tightly controlled diabetes than those with suboptimal control.2 Glycemic control in addition to control of hypertension (HTN) and dyslipidemia are important in the management of diabetes. Clinical trials have shown that diabetes is highly preventable in those most at risk by moderate exercise and modest weight loss, and that this is more effective than drug therapy in preventing diabetes.3,4 With these sobering facts in mind, it is important for primary care providers to be aware of the current standards of care for treating diabetes and preventing its complications as well as to understand effective therapies for diabetes in all its stages.5


There are two main clinical classifications of diabetes mellitus: type 1 diabetes and type 2 diabetes. Other specific types of diabetes (genetic defects in pancreatic β-cell function or insulin action, diseases of the exocrine pancreas, and drug or chemical induced diabetes) and gestational diabetes are less common and will be deferred to more detailed texts.6


Type 1 Diabetes


In type 1 diabetes there is little or no pancreatic secretion of insulin as a result of autoimmune β-cell destruction, requiring the patient to be treated with insulin replacement therapy in order to survive. While this type of diabetes most frequently appears in childhood or adolescence, it is possible to develop type 1 diabetes in adulthood. Patients with type 1 diabetes are classically thin or underweight, the result of chronic insulin deficiency and the resultant inability to utilize and store carbohydrate calories. Insulin resistance plays no part ...

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