1. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Epidemiology and Diagnosis

2. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. This program and all of its components are the exclusive property of and are copyrighted by Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. The contents of this program, including design and written information, may not be altered in any way. This program may not be disseminated, reproduced, copied, or published other than with the prior express written consent from Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved.

3. Etiologic Classification of Diabetes Mellitus Type 1  -cell destruction with lack of insulin Type 2Insulin resistance with insulin deficiency Other specific typesGenetic defects in  -cell function, exocrine pancreas diseases, endo- crinopathies, drug- or chemical- induced, and other rare forms GestationalInsulin resistance with  -cell dysfunction Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.

4. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Glucose Tolerance Categories Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197. FPG 126 mg/dL 110 mg/dL 7.0 mmol/L 6.1 mmol/L Impaired Fasting Glucose Normal 2-Hour PG on OGTT 200 mg/dL 140 mg/dL 11.1mmol/L 7.8mmol/L Diabetes Mellitus Impaired Glucose Tolerance Normal Diabetes Mellitus

5. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Diagnosis of Diabetes: Plasma Glucose Cutoff Points FPG 2-Hour PG on OGTT Categorymg/dLmmol/Lmg/dLmmol/L Normal<110<6.1<140<7.8 IFG>110 and 6.1 and <6.9—— IGT—— >140 and 7.8 and <11.1 Diabetes >126 >7.0 >200 >11.1 Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.

6. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Diagnosis of Diabetes: Three Methods 1.Random plasma glucose >200 mg/dL on 2 separate occasions + symptoms (polyuria, polydipsia, unexplained weight loss) 2.FPG >126 mg/dL on 2 separate occasions 3.2-hour plasma glucose >200 mg/dL during OGTT on 2 separate occasions Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.

7. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Estimated Prevalence of Diabetes in the US: Adult Men and Women Harris, et al. Diabetes Care. 1998;21:518-524, with permission. 0 10 20 30 75+60-7450-5940-4920-39 Age (y) 1.61.7 6.8 6.1 12.9 12.4 20.2 17.8 21.1 17.5 Men Women Percent of Population

8. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Diagnosed and Undiagnosed Diabetes in the US: Estimated Cases Among Adults, 1997 Data from Harris, et al. Diabetes Care. 1998;21:518-524. 0 2 4 6 8 10 12 UndiagnosedDiagnosed 10.2 5.4 Millions of Cases

9. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. Estimated Prevalence of Diabetes in the US: Breakdown by Ethnicity Data from Harris, et al. Diabetes Care. 1998;21:518-524. 4.8 2.5 8.2 3.6 9.3 4.5 0 2 4 6 8 10 Hispanic American African American Non-Hispanic White Diagnosed Undiagnosed Percent of Population

10. ©1999, Medical Age Publishing, Division of Snyder Healthcare Communications Worldwide, Stamford, Connecticut. All rights reserved. 1997 Per Capita Health Care Costs: Persons With and Without Diabetes Data from American Diabetes Association. Diabetes Care. 1998;21:296-309. Annual Costs ($1000s) 0 5 10 15 20 25 Outpatient Drugs Office Visits EROutpatient Services Inpatient 23.5 12.2 2.5 1.5 0.7 0.4 0.7 0.4 0.7 0.2 Diabetes No diabetes