EPIDEMIOLOGY OF DIABETES - LESSONS FOR THE ENDOCRINOLOGIST

Diabetes mellitus now occurs in at least 100 million people worldwide, and it is estimated that by 2010 this will have more than doubled to 230 million. The impact of this increase will be far reaching through the micro and macrovascular complications of diabetes, which lead to b lind ness, amputation, renal failure, and cardiovascular disease. Epid emiology is but one branch of medical science involved in the study of diabetes and is directed mainly at understanding the changing disease distribution, the causes and risk factors of diabetes, and the likely effect of interventions to prevent diabetes or its complications. Cla ssification and diagnostic criteria for diabetes are integral to diabe tes epidemiology because changes in these can dramatically alter preva lence estimates; at the same time, however, epidemiology can inform th e debate on revised classification systems for diabetes. This review e xamines some of the key issues in diabetes epidemiology today: the Nat ional Diabetes Data Group and World Health Organization revised diabet es classifications based on etiology, the anticipated epidemic of diab etes, and factors contributing to increases in both Type 1 and Type 2 diabetes, complications of diabetes, and issues involved with diabetes screening. In the absence of effective interventions for both Type 1 diabetes and Type 2 diabetes, the disease appears set to escalate worl d wide with the main impact being seen in developing nations. Thus, fi nding ways to prevent or delay the onset of diabetes and finding effec tive treatment to prevent its microvascular and macrovascular complica tions are essential components of future public health strategies for all nations.