In the United States (US), diabetes mellitus is a serious and costly public health problem, affecting more than 16 million people. Its incidence will continue to grow, as indicated by high rates of impaired fasting glucose levels, increased rates of obesity, and the trend toward more sedentary lifestyles. The prevalence of diabetes increases with age and varies by gender, race, and ethnicity. Diabetes also presents an enormous economic burden in the US. In 1996, total health care costs were 1 trillion dollars, 120 million dollars of which was for diabetes. A large proportion of the per-person costs associated with diabetes is for treating diabetic complications. Morbidity and mortality rates are higher in patients with diabetes than in patients without diabetes. There has been some recent improvement in type 2 diabetes treatment with the availability of newer medications, including secretagogues, metformin, acarbose, and the 'glitazones'. More patients are now using oral combination therapy, and fewer patients are using insulin. Unfortunately, many patients with type 2 diabetes are delaying the use of insulin, even when it is indicated for their treatment. Moreover, even with the new classes of oral antidiabetic agents, glycemic control remains suboptimal and patients still are not reaching the recommended target values for HbA(1c) (<7%). Primary medical care for diabetes patients is also less than optimal and must be improved. On an arbitrary gradient scale of 1 to 4 (with 1 being primitive and 4 being comprehensive), the US is only at stage 2 for diabetes care systems, indicating a pressing need for improvement in diabetes care.
Copyright 2002 John Wiley & Sons, Ltd.