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ETIOLOGY AND PREVALENCE
Diabetes mellitus (DM) comprises a group of metabolic disorders that share the common feature of hyperglycemia. DM is currently classified on the basis of the pathogenic process that leads to hyperglycemia. Type 1 DM is characterized by insulin deficiency and a tendency to develop ketosis, whereas type 2 DM is a heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and excessive hepatic glucose production. Other specific types include DM caused by genetic defects (maturity-onset diabetes of the young [MODY] and other rare monogenic disorders), diseases of the exocrine pancreas (chronic pancreatitis, cystic fibrosis, hemochromatosis), endocrinopathies (acromegaly, Cushing’s syndrome, glucagonoma, pheochromocytoma, hyperthyroidism), drugs (nicotinic acid, glucocorticoids, thiazides, protease inhibitors), and pregnancy (gestational DM). The phenotype of these monogenetic and secondary types of DM typically resembles type 2 DM; its severity depends on the degree of beta cell dysfunction and prevailing insulin resistance. Type 1 DM usually results from autoimmune destruction of pancreatic beta cells; it is also known as juvenile-onset diabetes because its peak incidence is in children and adolescents.
The prevalence of DM is increasing rapidly; type 2 DM frequency in particular is rising in parallel with the epidemic of obesity (Chap. 172). Between 1985 and 2013, the worldwide prevalence of DM has risen more than 10-fold, from 30 million to 382 million cases. In the United States, DM prevalence at greater than 8% of the population, increasing with age. A significant portion of persons with DM are undiagnosed.
DM is attended by serious morbidity and significant mortality; it is the fifth leading cause of death worldwide.