RSS Feeds
Treating Type 2 Diabetes with Respect
Until recently, type 2 diabetes mellitus received little respect from clinicians or patients, especially compared with its sibling, type 1 diabetes. Type 1 diabetes—characterized by onset at a young age, dramatic presentation, and acute metabolic emergencies (such as ketoacidosis)—has commanded our attention since its description more than 2000 years ago. Moreover, celebrity spokespersons have raised public awareness of this disease. Much basic and clinical diabetes research has focused on the pathophysiology and treatment of type 1 diabetes. This has resulted in the discovery and use of insulin, development of glucose monitoring devices, and the means of replacing deficient insulin secretion in a physiologic pattern with multiple daily injections and external and implantable pumps. In contrast, clear appreciation of a form of diabetes distinct from the “juvenile-onset” form did not emerge until the mid-1930s (1). The “adult-onset” form has often been treated dismissively as a mild form of diabetes that does not cause the litany of severe complications associated with type 1 diabetes.
We have finally awakened to the fact that type 2 diabetes, whose very designation suggests second- class citizenship, is actually the predominant form of diabetes and is a major public health problem in the United States and elsewhere. Epidemiologic surveys reveal that type 2 diabetes is one of the most common chronic severe diseases in the world, affecting an estimated 12% of the adult population aged 40 to 74 years in the United States (2). Moreover, the clinical characteristics of type …
