Diabetes mellitus has emerged during the past decade as an important clinical and public health problem in the United States.1 It is now the leading cause of blindness, the leading cause of end-stage renal disease, and the leading cause of lower-extremity amputations. In addition, people with diabetes have rates of coronary heart disease and stroke that are 2 to 5 times those of people who do not have diabetes. Medical care for diabetic patients has been estimated to cost $100 billion per year, accounting for 15% of all health care costs in the United States and 25% of all Medicare costs.
See also p 1246.
About 8 million adults in the United States have been diagnosed as having diabetes, approximately 90% to 95% of whom have non—insulin-dependent diabetes mellitus (NIDDM). The prevalence of known cases of diabetes is 6% to 7% for people aged 45 to 64 years and