I. SIZE OF THE PROBLEM A. Incidence
Presently there are more than 16 million type 2 diabetics in the United States, and it is expected that this number will rise to approximately 22 million adults with diabetes in the year 2025. In addition, there are greater than 40 million individuals who may not satisfy strict criteria for the diagnosis of diabetes but have normal or mini¬mally elevated blood glucose levels with associated hyper-insulinemia and peripheral insulin resistance. These ‘‘prediabetic’’ individuals have a 10% annualized risk of developing type 2 diabetes. Importantly, most diabetics die of cardiovascular disease, and atherosclerosis that causes obstruction to arteries in the heart and brain accounts for greater than 80% of all diabetic mortality.
Worldwide the incidence of diabetes differs greatly. Indians living in India have a much higher rate of diabetes than those Indians observed in the United States. This incidence is increased after Indians immigrate from their country, and here they have been shown to have a higher rate of diabetes than other ethnic groups. This well-recognized observation has been noted in Indians living in Singapore, South Africa, Malaysia, Fiji, and Trinidad. The prevalence of diabetes is greater than 35% among Pima Indians versus approximately 4% in the non-Pima Indian population in the United States. In randomized clinical trials conducted in the United States that involve patients with heart disease, stroke, or cardiovascular diseases, greater than 20% are diabetics, however. The Chinese and Eskimos have a much lower prevalence of diabetes.