Diabetes Control

Diabetes mellitus is a chronic metabolic disease characterized by an in­sufficient supply of the pancreatic islet hormone, insulin, or interference with its effective action, and increased glucose concentrations in the blood and urine. To the individual diabetic patient, the disease represents a serious threat because of the last complications that frequently occur; to the community, diabetes is a public health problem of considerable mag­nitude because of its high prevalence and the serious nature of its complications.

Community surveys, notably the one carried out in Oxford, Massa­chusetts, indicate that at least 1.5 to 2.0 percent of the population have diabetes and that approximately half of those with the disease are unaware of the fact that they have it. It has been estimated that there are two million known diabetic persons in the United States and about an equal number would be found and accepted as diabetic by a physician.

The severity of diabetes is suggested by the fact that this disease re­mains one of the ten most commonly reported causes of death, although the reported morbidity rate of diabetes is notoriously inaccurate. Death most often is due to cardiovascular-renal complications resulting from premature atherosclerosis. Diabetes, together with its complications, is a common reason for hospitalization and a common cause of complications of pregnancy. It is second only to cataracts and glaucoma as a cause of blindness.

EPIDEMIOLOGICAL ASPECTS

Diabetes mellitus is known to be genetically conditioned. This fact has two practical implications: (a) it influences the advice that should be given to two diabetics who are considering marriage, and (b) it helps in diabetes detection, since the disease is commonly found among the rela­tives of known diabetics.

It seems probable that for diabetes to become clinically manifested, there has to be one or more precipitating factors. The development of obesity is one such factor. Others include advancing age; endocrine dis­turbances, especially of the pituitary gland; and stress, such as acute in­fections, surgery, or psychological trauma.

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