The diabetes epidemic: a national and global crisis.

Diabetes mellitus is a serious problem that will soon reach epidemic proportions in the United States and throughout the world. The incidence of this condition will skyrocket in the next quarter century as demographic changes increase the size of highly susceptible populations (e.g., the elderly and Hispanic communities) and sociocultural developments create a more sedentary populace as well as expose people in developing nations to new risk factors for this disease. Along with substantial direct morbidity and mortality, diabetes is independently associated with the incidence and severity of a variety of cardiovascular illnesses. Individuals with diabetes are substantially more likely than their nondiabetic counterparts to suffer stroke, myocardial infarction, or heart failure, with a worse prognosis following any of these conditions. Many factors may be relevant to this association, but recent studies have elucidated a major role for the metabolic syndrome, which has been shown to be predictive of both diabetes and cardiovascular disease. Consequently, early intervention to control blood glucose levels and other risk factors may mitigate the severity of these conditions, possibly even before the disease begins.