![]() 14 The onset of type 2 diabetes usually precedes clinical diagnosis by several years. 14 Approximately 90% of patients with diabetes have the type 2 variety. 14 Another 5.4 million are estimated to have undiagnosed diabetes. Nonetheless, type 1 diabetes will be integrated into the overall strategy of cardiovascular risk reduction.Īt least 10.3 million Americans carry a diagnosis of diabetes mellitus. 13 Because type 2 diabetes occurs much more commonly than type 1 diabetes, the present statement will emphasize type 2 diabetes. This form of diabetes frequently produces microvascular complications, nephropathy, and retinopathy, 12 but it also predisposes to CHD. 12 Type 1 diabetes usually begins early in life and is often called juvenile diabetes. The other form of diabetes mellitus is type 1 diabetes, which follows immunologic destruction of pancreatic β-cells. Furthermore, the terms insulin-dependent diabetes mellitus and non–insulin-dependent diabetes mellitus have been replaced by type 1 diabetes and type 2 diabetes, respectively. These changes removed the need for oral glucose tolerance testing for diagnosis of diabetes a diagnosis rests entirely on confirmed elevations of fasting plasma glucose. A fasting plasma glucose of 110 to 125 mg/dL is now designated IGF. The upper threshold for normoglycemia likewise has been reduced from <115 to <110 mg/dL. 9 The upper threshold of fasting plasma glucose for the diagnosis of diabetes has been lowered from ≥140 mg/dL to ≥126 mg/dL. Recently, new criteria have been accepted for the diagnosis of diabetes. 10 The metabolic syndrome commonly precedes the development of type 2 diabetes by many years 11 of great importance, the risk factors that constitute this syndrome contribute independently to CVD risk. Many patients with the metabolic syndrome manifest impaired fasting glucose (IFG) 9 even when they do not have overt diabetes mellitus. 7 8 The common clustering of these risk factors in a single individual has been called the metabolic syndrome. 5 6 Insulin resistance typically precedes the onset of type 2 diabetes and is commonly accompanied by other cardiovascular risk factors: dyslipidemia, hypertension, and prothrombotic factors. 1 2 Insulin secretion declines with advancing age, 3 4 and this decline may be accelerated by genetic factors. Insulin resistance develops from obesity and physical inactivity, acting on a substrate of genetic susceptibility. The underlying metabolic causes of type 2 diabetes are the combination of impairment in insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic β-cells. This disorder typically makes its appearance later in life. The most prevalent form of diabetes mellitus is type 2 diabetes. Customer Service and Ordering InformationĬlinical Presentations of Diabetes Mellitus.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
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