ORIGINAL ARTICLES Type 2 Diabetes Mellitus: The Grand Overview

Type 2 diabetes currently accounts for over 100 billion dollars in annual healthcare expenditure in the United States and 28 % of the national (Medicare) healthcare budget for elderly Americans. In our inner-city hospital, 20 % of all 950 beds are occupied by patients with diabetes; and 28–38 % of patients receiving cardiac care in Coronary Care Units, catheterization laboratories or cardiovascular surgery, have diabetes as an underlying disorder. Both computer modelling and controlled clinical trials suggest that intensive therapy of diabetes can reduce significantly the morbidity and costs associated with this increasingly common disorder. Early detection of carbohydrate intolerance holds great promise for preventing the onset, progression and complications of Type 2 diabetes. To date our efforts have been futile, with 20 % of newly diagnosed Type 2 diabetic patients already complicated by retinopathy and 14 % complicated by peripheral vascular disease. It is now clear that high-risk individuals can be identified, and intervention trials are underway to test the hypothesis that Type 2 diabetes (and its attendant cardiovascular risks) can be prevented. The Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP NIDDM) in Canada and Europe has randomized 1200 individuals with impaire