International
Textbook of
Diabetes Mellitus

As the epidemic of diabetes continues to expand in parallel
with the rapid spread of obesity, healthcare providers strive
to find interventions to reduce the morbidity, mortality, and
rising costs associated with this devastating disease, which
ravages both the micro- and the macrovasculature. Although
the increase in incidence of type 2 diabetes may be attributed
to the expanding girth of the population coupled with a lack of
physical activity, the marked increase in the incidence of type 1
diabetes remains unexplained. Our knowledge of the cellular,
biochemical, and molecular etiology of impaired insulin action
and beta-cell failure has expanded enormously, but the genetic
basis of both type 1 and type 2 diabetes and their associated
complications is still by and large undefined. Despite the introduction of multiple new classes of antidiabetic agents for the
treatment of type 2 diabetes, and newer insulin preparations,
insulin delivery systems, and glucose-sensing devices for the
management of type 1 diabetes, glycemic control is suboptimal
in approximately half of all diabetic patients and the excess
risk for macrovascular complications is largely unexplained.
In many parts of the world, these treatment advances are not
available and instituting behavioral modification programs at
the societal and individual level is proving to be inadequate
in curbing the growing epidemic of obesity. Whether the
introduction of novel weight loss medications will stem the tide
of obesity remains to be determined.