Update on diabetes medical management: Epidemiology and treatment

Abstract

Diabetes represents a group of metabolic disorders which is affecting a growing number of people. It is estimated that worldwide about 8.8% of the adult population have diabetes and another 7% has prediabetes. Type 2 diabetes is the most common form and accounts for about 90-95% of cases. Diabetes in most developed countries is the leading cause of cardiovascular disease, adult-onset blindness, kidney failure, and lower-limb amputation. The goal of diabetes treatment is the prevention of diabetes emergencies and prevention of complications. Diabetes emergencies for type 1 and type 2 diabetes include diabetes ketoacidosis and the hyperosmolar hyperglycemic state, respectively. Long-term complications of hyperglycemia include microvascular complications such as retinopathy, nephropathy, neuropathy, and macrovascular complications which include coronary artery disease, peripheral artery disease, and cerebrovascular disease. While treatment for type 1 diabetes mostly relies on insulin treatment, for patients with type 2 diabetes, there are now medications which have been shown to have also beneficial cardiovascular effects. We are therefore moving to a new era where in addition to glucose control it is now also possible to target the cardiovascular system. It is crucial that patients acquire awareness of diabetes and its complications since this is often poorly appreciated. This chapter will focus on the current epidemiology and treatment of type 1 and type 2 diabetes in adults.