Diabetes Mellitus:

Diabetes mellitus is a metabolic disorder that is characterized by hyperglycemia. Several distant types of DM exists and are caused by complex interactions of genetics and environmental factors. Depending on the etiology of DM, factors contributing to hyperglycemia include o Reduced insulin secretion o Decreased glucose utilization o Increased glucose production

The metabolic dysregulation associated with DM causes secondary pathophysiological changes in multiple organ systems.

DM is the leading cause of ESRD, non-traumatic lower extremity amputations and adult blindness. It also predisposes to cardiovascular diseases with an increasing incidence worldwide, DM will be a leading cause of morbidity and mortality for the foreseeable future.

Globally the health care cost for diabetic persons of 20-79 years is estimated to be $153 billion annually12. 1. Powers AC. Diabetes mellitus. In: Harrisons Principles of Internal Medicine. 17th edition. International edition. Mc Graw Hill 2008 2275-2304. 2. Increasing blood pressure (BP) is correlated with an increasing risk of end-stage renal disease (ESRD; due to any cause). 3. In a study of 330,000 men screened for the Multiple Risk Factor Intervention trial (MRFIT) and followed up for an average of 16 years, an increase in the incidence of ESRD (requiring treatment or leading to death) was observed with increasing BP.

4. An elevated BP of only 130/85 to 139/89 (i.e. below the commonly used threshold for a diagnosis of hypertension) significantly increased the likelihood of ESRD, with an adjusted relative risk rate of 1.9 (p<0.001 vs men with optimal BP). In patients with a BP of 160/100 to 179/109, the risk rate tripled to 6, and in those with a BP >210/120, the adjusted relative risk of ESRD was 22.1. 5. Abbreviations 6. BP = blood pressure 7. ESRD = end-stage renal disease 8. MRFIT = Multiple Risk Factor Intervention trial 9. Reference 10. Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in men. N Engl J Med 1996;334:1318.