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October 20, 1993

International Textbook of Diabetes Mellitus

JAMA. 1993;270(15):1871. doi:10.1001/jama.1993.03510150107047

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Diabetes mellitus is the most expensive disease in the Western world. There are 14 million people with diabetes in the United States. That translates to more than one in 20 citizens. Diabetes is the leading cause of adult blindness and nontraumatic amputation. It is the primary cause of end-stage renal failure leading to dialysis. People with diabetes are two to five times more likely to have a stroke and twice as likely to have heart disease.

Diabetes mellitus is said to be the third most common reason a patient visits a doctor's office. In our 1100-bed medical center, one in nine patients had diabetes mellitus as a discharge diagnosis for 1991.

The combination of diabetes mellitus and syndrome X (hypertension, lipid abnormalities, and android obesity) perhaps accounts for most of the deaths in the United States. The net result of these extremely common problems—diabetes, hypertension, hyperlipidemia—is heart disease: the leading