THE GLOBAL EPIDEMIOLOGY OF NON-INSULIN-DEPENDENT DIABETES-MELLITUS AND THE METABOLIC SYNDROME

Non-insulin-dependent diabetes mellitus (NIDDM) constitutes about 85% of all cases of diabetes in developed countries and it has now reached epidemic proportions in many developing nations, as well as disadvant aged groups in developed countries, e.g., Mexican- and African-America ns and Australian Aborigines and Torres Strait Islanders. The diagnosi s of NIDDM is usually made after the age of 50 years in Europids, but it is seen at much younger age in these high prevalence populations, w hich also include Pacific Islanders, Native Americans, and migrant Asi an Indians and Chinese. There is enormous variation in NIDDM prevalenc e between populations, and exceptionally high rates have been document ed in populations who have changed from a traditional to a modern life style, e.g., American Pima Indians, Micronesians, and other Pacific Is landers, Australian Aborigines, migrant Asian Indians, and Mexican-Ame ricans. Over the next decade, following the initial phase of the NIDDM epidemic, macro- and microvascular complications will emerge as a maj or threat to future public health throughout the world with huge econo mic and social costs. The major cause of death in NIDDM is macrovascul ar disease (coronary artery, peripheral vascular, and cerebrovascular) , which accounts for at least two-thirds ol: NIDDM mortality. A key st rategy in reducing macrovascular disease lies in the better understand ing of the Deadly Quartet or Metabolic Syndrome. New data suggest that hyperleptinemia rather than hyperinsulinemia may play an important an d central role in the genesis of the cardiovascular disease risk facto r cluster that constitutes the Metabolic Syndrome. (C) Elsevier Scienc e Inc., 1997.