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Diabetes mellitus (DM) is a group of metabolic diseases characterizedby hyperglycemia resulting from defects in insulin secretion,insulin action, or both.1 Hyperglycemia further results in acute and chronic complications of the disease, leading to significant morbidity and mortality. Per the Centers for Disease Control and Prevention,2 20.8 million people, or 7% of the U.S. population, have diabetes, of which 6.2 million are undiagnosed. One in every 400 to 600 children and adolescents has type 1 diabetes. It has been estimated that direct and indirect costs of diabetes in the U.S. exceeded $132 billion in 2002.3

Complications of DM can be acute, life-threatening emergencies or chronic complications that serve as confounders in management of other emergency conditions.

The classification of diabetes has evolved as we have gained understanding of the etiology and pathogenesis of the disease. Classifications into insulin-dependent versus non–insulin-dependent DM, or juvenile-onset versus maturity-onset DM or type 1 versus type 2 diabetes, are less commonly used now. Table 218-0.1 explains the etiologic classification of diabetes as used by the American Diabetes Association (ADA).1

Table 218-0.1 Etiologic Classification of Diabetes Mellitus

Type 1 diabetes is characterized by almost no circulating insulin and the failure of β-cells to respond to insulinogenic stimuli. This accounts for only 5% to 10% of all cases of diabetes and is mostly diagnosed in children and young adults, with peaks before school age and at puberty. Immune-mediated destruction of β-cells causes 90% of these cases, and the remainder have no known etiology for insulinopenia. Spontaneous ketoacidosis almost always develops in untreated cases, and insulin is required for survival.

In contrast, type 2 diabetes is much more common, comprising 80% to 90% of all diabetics in the U.S. Here the defect includes a failure of circulating insulin to act on various tissues (“insulin resistance”), a relative insulin deficiency, or a combination of both (i.e., a ...

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