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.
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
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
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 to
be determined. This conclusion is mainly based on the studies on Asian
Americans, who have shown a higher prevalence of T2DM diabetes (Table 219-1).
Table 219-1 Epidemiology of Type 2 Diabetes Mellitus (T2DM)
| Save Table
Table 219-1 Epidemiology of Type 2 Diabetes Mellitus (T2DM)
|T2DM Epidemiology Fact Sheet|
|Prevalence of T2DM can vary depending on geography, age,
sex, and race/ethnicity status.|
|In up to 30% of the affected people, the disease
|Prevalence of T2DM is rising globally, with a greater increase
in the developing countries.|
|There is an alarming trend toward increasing prevalence of
T2DM among youth.|
|T2DM patients show a greater risk of mortality than nondiabetic
|Diabetes is the leading cause of blindness, end-stage renal
disease, and nontraumatic lower limb amputations.|
Alarming increases in the prevalence of T2DM have
occurred both in the U.S. and worldwide. About 6.3% of
the U.S. population—more than 18 million people—has
diabetes. Between 2000 and 2005, an average annual increase of 5.7% was
noted among French diabetic patients,2 and in Australia,
the Diabetes, Obesity and Lifestyle study reported in 2000 that
the prevalence of diabetes has more than doubled since 1981. It
has been speculated that the global prevalence of this type of diabetes
would increase from 4% in 1995 to 5.4% in the
year 2025 (which means about 300 million affected people worldwide).
Most of this increased burden will occur in developing countries.
This disproportionate rise results, at least in part, from the shift
toward a “westernized” lifestyle with high-calorie diets
and decreased physical activities. World Health Organization experts
have projected that in 2030, >75% of all diabetic populations
will live in developing countries (this figure was 62% in
T2DM is more common among women than men, and its prevalence
increases by age (Figure 219-0.1). The prevalence
of T2DM among youth is rising dramatically. In the past, only 1% to
2% of diabetic children were considered to have T2DM, whereas
later reports suggest that as many as 8% to 45% of
children with newly diagnosed diabetes may have this type of diabetes.
Investigators attribute this rise to patterns of obesity and lack of
Estimated total prevalence of diabetes in people aged
20 years or older, by age group—U.S., 2005. (Reproduced
from National Institute of Diabetes and Digestive and Kidney Diseases:
National Diabetes Statistics fact sheet: general information and
national estimates on diabetes in the United States, 2005. Bethesda,
MD: U.S. Department of Health and Human Services, National Institute
of Health, 2005. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm.)
Prevalence of diabetes can vary widely depending on race/ethnicity
and socioeconomic status. Native Americans, blacks, and Americans
of Mexican or Japanese ethnicity are more commonly affected by T2DM
than non-Hispanic whites (Figure 219-1).
Log In to View More
If you don't have a subscription, please view our individual subscription options
below to find out how you can gain access to this content.
Want access to your institution's subscription?
Sign in to your MyAccess Account while you are actively authenticated on this website
via your institution (you will be able to tell by looking in the top right corner
of any page – if you see your institution’s name, you are authenticated). You will
then be able to access your institute’s content/subscription for 90 days from any
location, after which you must repeat this process for continued access.
If your institution subscribes to this resource, and you don't have a MyAccess account,
please contact your library's reference desk for information on how to gain access
to this resource from off-campus.
AccessMedicine Full Site: One-Year Subscription
Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.
Pay Per View: Timed Access to all of AccessMedicine
48 Hour Subscription
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.