Abstract
Diabetes mellitus is a major contributor to morbidity and mortality in society. It is the leading cause of blindness in adults, the most frequent cause of end-stage renal disease, the most important reason for amputation after trauma, and an important risk factor for atherosclerotic vascular disease.
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The cost of diabetes to the US economy has quadrupled over the past decade and reached $105 billion in 1995, exceeding that of cancer and heart disease. Greater than 90% of all diabetic subjects have type 2 diabetes (about 16 million individuals), half of whom are thought to be undiagnosed.
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It has been estimated that newly diagnosed patients have been hyperglycemic for 5 to 10 years before they are diagnosed, so that 10% to 20% of such individuals have evidence of tissue complications at diagnosis.
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Furthermore, the incidence of type 2 diabetes has increased steadily in the United States over the past four decades, particularly in minority ethnic groups.
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Although the benefits of intensified glycemic control in preventing microangiopathic complications have been established,
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there is little evidence that there have been substantial improvements in the health of the average patient with diabetes. In addition, there is considerable uncertainty that improved glycemic control significantly reduces the problem of diabetic macroangiopathy. Prospective studies suggest that other cardiovascular risk factors associated with diabetes, such as dyslipidemia, hypertension, and a procoagulant state, may predate the emergence of hyperglycemia for many years.
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It is for these reasons that new approaches to the problem need to be considered. Improvements in understanding of the natural history and the etiopathogenesis of type 2 diabetes indicate that this disease usually has a prolonged prediabetic phase. This raises the possibility that individuals destined to develop type 2 diabetes might be identified before its inception, for preventive management and treatment.
