Diabetes and its complications constitute a significant public health problem worldwide and are an important cause of morbidity and mortality. In fact, diabetes has reached epidemic proportions throughout the world, and the prevalence is expected to continue to rise. The International Diabetes Federation estimates that more than 245 million people around the world have diabetes (4). This total is expected to rise to 380 million within 20 years. Each year a further 7 million people develop diabetes. Diabetes, mostly type 2 diabetes (T2D), now affects 5.9% of the world's adult population with almost 80% of the total in developing countries. The regions with the highest rates are the Eastern Mediterranean and Middle East, where 9.2% of the adult population is affected, and North America (8.4%). The highest numbers, however, are found in the Western Pacific, where some 67 million people have diabetes, followed by Europe with 53 million.

According to new 2007 prevalence data estimates recently released by the Centers for Disease Control and Prevention (CDC), diabetes now affects nearly 24 million people in the United States (USA), an increase of more than 3 million in approximately 2 years (5). Among adults, diabetes increased in both men and women and in all age groups, but still disproportionately affects the elderly. Almost 25% of the population aged 60 years and older had diabetes in 2007. Another 57 million people are estimated to have pre-diabetes. It has been projected that one in three Americans born in 2000 will develop diabetes, with the highest estimated lifetime risk among Latinos (males, 45.4% and females, 52.5%) (6).

A rise in obesity rates is to blame for much of the increase in T2D (7). Nearly two-thirds of American adults are overweight or obese (8). The prevalence of abdominal obesity (i.e., large waist circumference) among US adults has increased continuously during the past 15 years. Over one-half of US adults have abdominal obesity (9). This is a major concern given the strong association between measures reflecting abdominal obesity and the development of T2D (10).

The risk of developing diabetes rises not only with overweight/obesity (body mass index, BMI>25 kg/m2) and lack of physical activity, but with increasing age (>45 years) and family history (1). Specific population subgroups have a higher prevalence of diabetes than the population as a whole. Recent data showed that compared to white non-Hispanics (6.6%) diabetes remains higher in race/ethnic minority groups: Native Americans and Alaska Natives (16.5%), African Americans (11.8%), Latinos (10.4%), which includes rates for Puerto Ricans (12.6%), Mexican Americans (11.9%), and Cubans (8.2%), and Asian Americans (7.5%) (11). Women with a history of prior gestational diabetes or polycystic ovarian syndrome are at increased risk. Also, the predictive value of traditional and non-traditional risk factors has been evaluated in cohort studies (12, 13). In addition to age, family history of diabetes, obesity and pre-diabetes, and those with other metabolic syndrome components (high blood pressure, low HDL cholesterol, and high triglycerides) are at higher risk. The greater the number of these metabolic risk factors in a given person, the higher the chance of that individual developing diabetes.

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