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Type 2 diabetes mellitus (T2DM) is a complex, chronic metabolic
disorder characterized by hyperglycemia and associated with a relative deficiency
of insulin production, along with a reduced response of the target
tissues to insulin. It is a major public health issue and an important
contributor to increased morbidity and mortality in the general population
all over the world.
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No nation is exempt from the concern of the so-called “diabetes
epidemic.” Diabetes is associated with a multitude of short-term
and long-term complications, and, hence, a clinical diagnosis of
diabetes mellitus is a costly occurrence in terms of health care
resource utilization and adverse health outcomes.2 In
the U.S. in 2002, the direct medical costs for treating diabetes
and its complications were calculated to be $92 billion.
Indirect costs, resulting from lost workdays, limited activity,
and lifelong disability, adds to this economic burden by another $40
billion. Blindness, chronic renal failure, and lower limb amputation
are the feared sequelae of diabetes. Emergency physicians face diabetes
under several circumstances: they may be called on to evaluate and
treat the acute or chronic complications of diabetes or of its treatment [such
as diabetic ketoacidosis (DKA), foot ulcer, or hypoglycemia],
or they may in some cases diagnose diabetes in a patient for the
first time. Moreover, a diabetic patient may be admitted to the
ED for a condition not directly related to diabetes and requires
consideration of his/her special needs. For these reasons,
a basic knowledge of diabetes is essential for every practicing emergency
physician.
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Lack of data from large representative samples and the fact that
diagnostic criteria are not mentioned in many published reports
make accurate projection of the prevalence of diabetes difficult.
It is, however, estimated that about 150 million people are afflicted
with diabetes across the world. T2DM is the predominant form of
diabetes and constitutes 90% of the cases globally. Two
percent to 3% of the world population is estimated to have
undiagnosed diabetes, and the prevalence of undiagnosed cases depends
on the availability of systematic screening programs. The rank of countries
for the number of diabetic patients is, in decreasing order, India,
followed by China, then the U.S.1
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In the U.S., the prevalence of T2DM among adults
was 6.5% in 1998. According to data collected from 1997
to 1999 by the National Health Information Survey, approximately
1 million new cases of diabetes were diagnosed each year in the
U.S., with 90% to 95% classified as T2DM. A study
conducted in the year 2000 in Australia reported that 7.4% of
the population aged 25 or over had diabetes (type 2 in 90% of
the cases), and that about 50% were undiagnosed. In the
U.K., around 1.2 million people are known to have T2DM. In 2005,
drug-treated diabetes affected 3.6% of the French population,
and T2DM accounted for 92% of these cases.2 Asians
are at higher risk of developing diabetes, but the reasons are yet ...