NIDDM - THE DEVASTATING DISEASE

Of the various types of diabetes mellitus, non-insulin-dependent diabe tes (NIDDM) is by far the most common and is increasing rapidly in man y populations around the world. It is a heterogeneous disorder, charac terized by a genetic predisposition and interaction between insulin re sistance and decreased pancreatic beta-cell function. There is a stron g association between the presence of obesity and low levels of physic al exercise and the development of NIDDM. However, NIDDM may also deve lop in lean individuals and the incidence increases significantly with increasing age. A diagnosis of impaired glucose tolerance or gestatio nal diabetes is a strong predictor for future development of NIDDM and should signal appropriate interventions to prevent or delay the progr ession to NIDDM. NIDDM is frequently associated with other conditions such as hypertension, hypertriglyceridemia and decreased high-density lipoprotein which are additional risk factors for atherosclerosis and cardiovascular disease. The 'insulin resistance syndrome', which inclu des obesity, NIDDM, hypertension, hyperinsulinemia and dyslipidemia is a major and increasing cause of morbidity and mortaility in many popu lations. In addition, people with NIDDM and poor glycemic control may develop severe microvascular complications of diabetes, including reti nopathy, nephropathy and neuropathy. Appropriate diet, weight control and increased physical activity will increase insulin sensitivity in i nsulin resistant patients and are effective treatments for patients wi th NIDDM or may prevent the development of NIDDM in susceptible indivi duals. If these measures are unsuccessful, then oral hypoglycemic agen ts or insulin therapy may be required. Maintaining near normal blood g lucose levels will decrease the development or progression of long-ter m complications of diabetes and should be a major goal of therapy, bal ancing intensive treatment with the increased risk of severe hypoglyce mia. Because of the increasing prevalence of NIDDM in many populations , increased awareness of the disease, surveillance of high-risk popula tions and early diagnosis and treatment are all important in reducing the morbidity associated with this disease.