Chapter 219

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 physician.

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 ...

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