Diabetes has become an increasing problem throughout the world, with an estimated 300million people expected to be diagnosed with the disease in the next 10 years. One hundredand fifty million people worldwide and 18.2 million people in the United States are currentlyafflicted, an additional 5.2 million are undiagnosed, and close to 16 million are insulinresistant.More than 9 million women, 8 million men, and 120,000 children under 18 yearsof age currently have this disease .

 

    Increasing obesity, dietary indiscretions, progressive physical inactivity, and advancingage of the population have all contributed to a sharp rise in the disease. In 1992, 2–4% of allnewly diagnosed cases of diabetes in children were type 2 diabetes. By 1999, this numberhad risen to 45%. African Americans are more hyperinsulinemic and insulin-resistant atpuberty with lower resting metabolic rates than white children.

 

    According to statistics published by The American Diabetic Association, 15% of the USpopulation has either impaired fasting glucose (6.9%), confirmed diabetes (5.9%), or undiagnoseddiabetes (2.8%), including an alarming 22.7% of Mexican-Americans (9.3% confirmed,4.5% undiagnosed, and 8.9% impaired fasting glucose), and 18.8% ofAfrican-American non-Hispanics (8.2% confirmed, 3.6% undiagnosed, and 7% impairedfasting glucose).

 

    Since 1980, the incidence rate of type 2 diabetes has increased by nearly 20%, with afivefold increase in children and adolescents since 1994. Each year, more than 798,000 newcases are diagnosed in the United States alone, with close to 180,000 diabetics succumbingto the disease and its devastations. Since 1970, the occurrence rate of this disease has risen700% in this country alone. According to the Centers for Disease Control and Prevention,33% of men and 39% of women born in 2000 will develop diabetes. The highest lifetimerisks are 45% for Hispanic men and 53% for Hispanic women. By the year 2025, nearly 22million adults in the United States and 300 million adults worldwide will have diabetes! Thisdisease is the leading cause of end-stage kidney disease and blindness in individualsbetween 20 and 74 years of age, and a major cause of peripheral neuropathy and peripheralvascular disease.

 

    Clearly, diagnosing and managing the type 2 diabetic represents a tremendous challengeto the primary care provider already besieged with managed care issues, medication costs,liability concerns, and health access.

 

    Type 2 Diabetes, Pre-Diabetes, and the Metabolic Syndrome: The Primary Care Guideto Diagnosis and Management, along with its Continuing Medical Education component,has been designed as a direct result of 5 years of lecturing throughout the country, listening,teaching, and empathizing with fellow primary care practitioners, and our ongoing fightwith this killer disease. I have designed this as an easy-to-reference, state-of-the-art guide toall primary care practitioners, students, caregivers, and patients battling the ravages of thismonster.