Family Medicine pp 1066-1076 | Cite as

Diabetes Mellitus

  • Charles Kent Smith
  • John P. Sheehan
  • Margaret M. Ulchaker


Diabetes mellitus (DM) affects 12 million to 15 million individuals in the United States, incurring an immense cost in terms of morbidity and premature death. The most common form is type II, or adult-onset, DM, which has racial preponderances, female predilection, and strong associations with obesity. There was a revolution in DM management during the 1980s with the advent of home blood glucose monitoring devices, human insulin, and reliable laboratory markers of long-term glycémie control. Additionally, published national and international standards of care have been disseminated directly to patients and physicians, heightening the importance of adequate care and glycémie control to minimize devastating long-term complications.1,2 Table 120.1 describes diagnostic criteria for diabetes mellitus, impaired glucose tolerance, and gestational diabetes.


Insulin Resistance Glycemic Control Insulin Therapy Ideal Body Weight Intensive Insulin Therapy 
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  1. 1.
    Clinical practice recommendations: 1990–1991. Diabetes Care 1991.14 Suppl 2:1–81.Google Scholar
  2. 2.
    The European patient’s charter. Diabet Med 1991;8:782–3.Google Scholar
  3. 3.
    Landin-Olsson M, Nilsson KO, Lernmark A, Sunkvist G. Islet cell antibodies and fasting C-peptide predict insulin requirement at diagnosis of diabetes mellitus. Diabetalogia 1990;33:561–8.CrossRefGoogle Scholar
  4. 4.
    Zeigler AG, Herskowitz RD, Jackson RA, Soeldner JS, Eisenbarth GS. Predicting type I diabetes. Diabetes Care 1990;13: 762–75.CrossRefGoogle Scholar
  5. 5.
    Keller RJ, Eisenbarth GS, Jackson RA. Insulin prophylaxis in individuals at high risk of type I diabetes. N Engl J Med 1993;341:927–8.Google Scholar
  6. 6.
    Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147–52.PubMedCrossRefGoogle Scholar
  7. 7.
    DeFronzo RA. The triumverate: B-cell, muscle, and liver: a collusion responsible for NIDDM. Diabetes 1988;37:667–87.PubMedGoogle Scholar
  8. 8.
    Erikkson J, Franssila-Kallunki A, Ekstrand A. Early metabolic defects in persons at increased risk for non-insulin-dependent diabetes mellitus. N Engl J Med 1989;321:337–43.CrossRefGoogle Scholar
  9. 9.
    DeFronzo RA, Bonadonna RC, Ferrannini E. Pathogenesis of NIDDM. Diabetes Care 1992;15:318–68.PubMedCrossRefGoogle Scholar
  10. 10.
    Clark PM, Hales CN. Measurement of insulin secretion in type 2 diabetes: problems and pitfalls. Diabet Med 1992; 9:503–12.PubMedCrossRefGoogle Scholar
  11. 11.
    Bjornstorp P. Metabolic implications of body fat distribution. Diabetes Care 1991;14:1132–43.CrossRefGoogle Scholar
  12. 12.
    Ferrannini E, Buzzigoli G, Bonadonna B, et al. Insulin resistance in essential hypertension. N Engl J Med 1987;317:350–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Zavaroni I, Bonora E, Pagliara M, et al. Risk factors for coronary artery disease in healthy persons with hyper-insulinemia and normal glucose tolerance. N Engl J Med 1989;320:703–6.CrossRefGoogle Scholar
  14. 14.
    Kern TS, Engerman RL. Arrest of glomerulonephropathy in diabetic dogs by improved glycemie control. Diabetalogia 1990;33:522–5.CrossRefGoogle Scholar
  15. 15.
    Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977–86.CrossRefGoogle Scholar
  16. 16.
    Viberti GC. Etiology and prognostic significance of albuminuria in diabetes. Diabetes Care 1988;11:840–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Deckert T, Feldt-Rasmussen B, Borch-Johnson K, Jensen T, Kofoed-Gnevoldsen A. Albuminuria reflects widespread vascular damage: the Steno hypothesis. Diabetologia 1989;32: 219–26.PubMedCrossRefGoogle Scholar
  18. 18.
    Marshall SM. Screening for microalbuminuria: which measurement? Diabet Med 1991;8:706–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Hamwi GL. Changing dietary concepts in therapy. In: Danowski TS, editor. Diabetes mellitus: diagnosis and treatment. New York: American Diabetes Association, 1964:73–8.Google Scholar
  20. 20.
    Wood FC, Bierman EL. Is diet the cornerstone in management of diabetes? N Engl J Med 1986;1244–7.Google Scholar
  21. 21.
    Zehrer C, Hansen R, Bantl J. Reducing blood glucose variability by use of abdominal injection sites. Diabetes Educator 1990;16:474–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Skyler JS, Skyler DL, Seigier DE, O’Sullivan M. Algorithms for adjustment of insulin dosage by patients who monitor blood glucose. Diabetes Care 1981;4:311–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Frykberg RG. Management of diabetic foot problems (Joslin Clinic). Philadelphia: Saunders, 1984.Google Scholar
  24. 24.
    Singerman LJ. Early-treatment diabetic retinopathy study: good news for diabetic patients and health care professionals [editorial]. Diabetes Care 1986;9:426–9.PubMedGoogle Scholar
  25. 25.
    Lewis EJ, Hunsicker LG, Bain RE, and Rohde RD. The effect of angiotenisin-converting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329:1456–62.PubMedCrossRefGoogle Scholar
  26. 26.
    Tuttle KR, Bruton JL, Perusek MC, Lancaster JL, Kopp DT, DeFronzo RA. Effect of strict glycémie control on renal enlargement in insulin-dependent diabetes mellitus. N Engl J Med 1991;324:1626–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988;148:36–69.Google Scholar
  28. 28.
    Role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes. Diabetes Care 1992;15:68–74.Google Scholar
  29. 29.
    Flynn MD, Tooke JE. Aetiology of diabetic foot ulceration: a role for the microcirculation? Diabet Med 1992;9:320–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Skyler JS. Insulin treatment: therapy for diabetes mellitus and related disorders. Alexandria, VA: American Diabetes Association, 1991:127–37.Google Scholar
  31. 31.
    Bhatia V, Wolfsdorf JL Severe hypoglycemia in youth with insulin-dependent diabetes mellitus: frequency and causative factors. Pediatrics 1991;88:1187–93.PubMedGoogle Scholar
  32. 32.
    Groop LC, Widen E, Ekstrand A, et al. Morning or bedtime NPH insulin combined with sulfonylureas in treatment of NIDDM. Diabetes Care 1992;15:831–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Proceedings of the Third International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes 1991 ;40 Suppl 2:1–201.Google Scholar
  34. 34.
    Jovanovic-Peterson L, Peterson CM. Pregnancy in the diabetic woman: guidelines for a successful outcome. Endocrinol Metab Clin North Am 1992;33:433–56.Google Scholar
  35. 35.
    Kaufmann RC, Amankwah KS, Woodrum J. Development of diabetes in previous gestational diabetic [abstract]. Diabetes 1991;40:137A.Google Scholar
  36. 36.
    Kaufmann RC, Amankwah KS, Woodrum J. Serum lipids in former gestational diabetics, [abstract]. Diabetes 1991;40:192A.Google Scholar
  37. 37.
    Kozak GP, Rolla AR. Diabetic comas. In: Kozak GP, editor. Clinical diabetes mellitus. Philadelphia: Saunders, 1982:109–45.Google Scholar
  38. 38.
    Siperstein MD. Diabetic ketoacidosis and hyperosmolar coma. Endocrinol Metab Clin North Am 1992;33:415–32.Google Scholar
  39. 39.
    Saltiel AR, Olefsky JM. Thiazolidinediones in the treatment of insulin resistance and type 2 diabetes. Diabetes 1966; 45:1661–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Charles Kent Smith
  • John P. Sheehan
  • Margaret M. Ulchaker

There are no affiliations available

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