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Insulin Delivery and Glucose Monitoring Methods for Diabetes Mellitus: Comparative Effectiveness

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Background: Definition of Diabetes Mellitus and Its Prevalence

Diabetes mellitus is defined as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion from the pancreatic beta-cells; resistance to insulin action at the level of skeletal muscle, liver, and fat; or both.

The prevalence of diagnosed diabetes in the United States is currently 7.7 percent and is expected to increase to nearly 10 percent by 2050, at which time an estimated 39 million people in the United States will have the disease.

Type 1 diabetes, which accounts for 5 to 10 percent of all diabetes cases, is characterized by autoimmune destruction of pancreatic islet cells that results in an inability to produce insulin and a need for daily insulin administration to sustain life. In the United States, the prevalence and incidence of type 1 diabetes is highest among non-Hispanic whites and lowest among Navajo Indians.

Type 2 diabetes is the result of a combination of insulin resistance and impaired insulin secretion by the beta-cells of the endocrine pancreas. Typically, insulin resistance predominates early, and insulin secretion decreases over time. Eventually, the impairment in insulin secretion resulting from beta-cell dysfunction can lead to insulin deficiency, necessitating insulin therapy. Type 2 diabetes accounts for 90 to 95 percent of diabetes cases in the United States. The prevalence and incidence of type 2 diabetes is highest among non-Hispanic blacks and lowest among non-Hispanic whites.