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Both the World Health Organization (WHO) and the International Diabetes Federation (IDF) consider worldwide diabetes prevalence to be at epidemic proportions. The IDF estimates that in 2010 more than 285 million people globally had diabetes and that this number is likely to increase to over 438 million by 2030.1 In the United States, type 2 diabetes (T2DM) is increasing faster than our health system can effectively support. Current national statistics estimate there are approximately 23.6 million individuals with diabetes and about 5.7 million people with T2DM who are undiagnosed.2,3

The impact of diabetes on overall health is far-reaching. Diabetes is a leading cause of adult blindness, lower-limb amputation, kidney disease, and nerve damage. Moreover, two thirds of people with diabetes die from heart disease or stroke. Beyond the existing diabetes epidemic, an estimated 57 million people are considered to have either the metabolic syndrome or what is now called "at risk for diabetes" (formerly prediabetes) and are not only at risk for developing type 2 diabetes,3 but their at risk for diabetes condition creates an environment that accelerates macrovascular disease. This in turn increases risk for stroke, coronary artery disease, and peripheral vascular disease at an earlier age and with more severe manifestations. Clearly, diabetes has a staggering negative impact on overall health. This chapter will examine its deleterious effects on the wound healing process specifically.

Definition and Description of Diabetes Mellitus

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.4 The etiology of diabetes has a variety of pathophysiologies. However, it is important to keep in mind that the etiology and pathophysiology of diabetes are complex and to date are incompletely understood. The three most frequently encountered forms of diabetes include type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes (GDM).

Type 1 diabetes mellitus (T1DM), which accounts for 5% to 10% of those affected with the disease, was previously called insulin-dependent diabetes mellitus (IDDM), or juvenile-onset diabetes. T1DM results from cellular-mediated autoimmune destruction of the pancreatic beta cells resulting in an absolute deficiency in insulin secretion.4 To survive, people with T1DM must administer insulin daily. T1DM usually occurs in children and young adults, although disease onset can occur at any age. Risk factors include autoimmune abnormalities, genetics, or environmental triggers.

Type 2 diabetes (T2DM), accounting for 90% to 95% of those affected, was previously called non-insulin-dependent diabetes mellitus (NIDDM), adult-onset diabetes, or secondary onset diabetes. T2DM is a progressive disease caused by a combination of complex metabolic disorders that result from coexisting defects of multiple organ sites, such as insulin resistance in muscle ...

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