The chances are you know someone who has diabetes. Almost 16 million people in the United States alone have some form of diabetes, although only about 10 million have been diagnosed - a sixfold increase over the past four decades. Additionally, there are close to 800,000 new cases diagnosed every year. Diabetes is the nation's seventh leading cause of death, contributing to more than 193,000 each year. The economic burden of this disease is evident in the American Diabetes Association estimates of $98 billion spent annually on the direct and indirect costs of diabetes in the United States.

      Diabetes is a disease that affects the body's ability to use digested food for growth and energy. Most of the food we eat is broken down into glucose, or sugar, our body's main source of fuel. After digestion, glucose enters the bloodstream where it is used by cells to be converted to energy.
      The pancreas, an organ that lies behind the stomach, produces a hormone called insulin that helps move glucose from the blood into our cells. In people with diabetes, the body either produces little or no insulin, or can't use its own insulin as well as it should. This causes glucose to build up in the blood (a condition known as hyperglycemia), overflow into the urine, and eventually pass out of the body, resulting in the loss of the body's main source of fuel.
      In advanced cases of the disease, diabetes can cause serious health complications including blindness, kidney disease, lower-extremity amputations, heart disease, stroke, high blood pressure, and nerve damage.

      The three main types of diabetes are type 1, type 2, and gestational. Type 1 diabetes, previously known as insulin-dependent diabetes mellitus or juvenile-onset diabetes, accounts for about 5 to 10 percent of all diagnosed cases in the United States. This type develops most commonly in children and young adults, but can appear at any age. In type 1 diabetes, the body's immune system attacks the insulin-producing cells in the pancreas, resulting in the production of little or no insulin. Individuals with this type of the disease need to take insulin daily in order to live. It is believed that genetic and environmental factors are involved in the development of this type of diabetes.
      The most common form of diabetes is type 2, previously called non-insulin-dependent diabetes mellitus or adult-onset diabetes. About 90 to 95 percent of people with diabetes have type 2. It usually develops in adults age 40 and older and is most common over the age of 55. Risk factors include older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. It is believed that about 80 percent of people with type 2 diabetes are overweight. Many of these individuals also have high blood pressure (hypertension) and high levels of blood lipids. Type 2 diabetes is becoming more common in younger people as more children become overweight.
      Gestational diabetes develops in 2 to 5 percent of all pregnancies. Although it usually disappears when a pregnancy is over, women who have had gestational diabetes are at increased risk for developing type 2 diabetes later in life.

      Diabetes and its various complications occur among Americans of all ages, males and females alike, but most often in older people. Whereas type 1 diabetes is more common in whites than in nonwhites, type 2 occurs more often in certain racial and ethnic populations, including African Americans, Hispanic Americans, American Indians, Alaska Natives, and Asian and Pacific Islander Americans. Additionally, people with a family history of diabetes are far more likely to develop the disease.
      The prevalence of diabetes in the United States is likely to increase due to widespread changes in lifestyle, and to population trends, in particular the aging babyboomer generation. In addition, Hispanic Americans and other minority groups make up the fastest growing segment of the U.S. population. Finally, and most important, Americans are becoming increasingly overweight and sedentary.

      The increasing burden of diabetes and its complications as a major public health problem is clearly alarming. However, much of this burden can be prevented with early detection and better education on diabetes self-management. Several of the most common diabetes-related complications can be prevented or significantly reduced by early detection and treatment, routine screenings and exams, and frequent monitoring of blood glucose (blood sugar) levels. Recent studies in both the United States and Europe showed that controling blood glucose levels reduces the risk of developing major complications of both type 1 and type 2 diabetes.
      Lifestyle factors play a major role in managing, and possibly even preventing, type 2 diabetes. In addition to home blood glucose testing, management of type 2 diabetes typically includes diet control and exercise, and in some cases, oral medication and/or insulin. A number of studies have clearly shown a relationship between eating habits, obesity, and activity levels and the risk of developing type 2 diabetes. Therefore, preventive approaches need to include identifying people at risk for this disease and encouraging them to lose weight, be more physically active, and follow a healthy eating plan.

      Often forgotten amidst the remarkable progress in drug treatment of diabetes, is the fact that until the discovery of insulin in the 1920s, the only treatment for diabetes was dietary. Today, the role of dietary intervention in managing type 2 diabetes is once again a major player in this ongoing public health challenge and the focus of much research. In addition to studying how the manipulation of foods can lower blood glucose concentrations, another area attracting attention is the potential effect of increasing the intake of dietary fiber to achieve similar results. Recent research suggests that a high intake of dietary fiber, particularly of the soluble type, improves blood glucose control in people with type 2 diabetes.
      Another area of inquiry regarding diabetes management is the role of chromium, an essential mineral that is involved primarily in the regulation of glucose metabolism. Research suggests that supplemental chromium may aid in the control of blood glucose levels.
      The potential benefits of dietary intervention in people with diabetes, including dietary supplements as appropriate, are reasonably clear and significant as a complement to the more traditional drug management approaches. Ongoing research in all areas of diabetes management is continually adding to our knowledge on how to better deal with this major health challenge.