Diabetes mellitus is a huge public health problem in the United States. Statistics from 2018 show that approximately 34.2 million (10.5%) Americans have diabetes mellitus, 7.3 million have the disease but are undiagnosed, and 88 million (33.9%) U.S. adults have pre-diabetes, most being unaware of their condition. In addition, the prevalence of diabetes mellitus has been steadily increasing since the late 1950s. Despite improvements in the number of people who have attained the recommended A1C level, there are still millions of Americans who have not achieved glycemic control.  The percentage of adults with diabetes has increased with age, reaching 26.8% among those aged 65 years or older.

New diabetes cases were higher among non-Hispanic blacks and people of Hispanic origin than non-Hispanic Asians and non-Hispanic whites. For adults diagnosed with diabetes: 1) New cases significantly decreased from 2008 through 2018 except in people under 20 years old, 2) The percentage of existing cases was highest among American Indians/Alaska Natives, 3) 15% were smokers, 89% were overweight, and 38% were physically inactive, 4) 37% had chronic kidney disease (stages 1 through 4); and, it’s interesting to note, that among those with kidney disease fewer than 25% with moderate to severe chronic kidney disease (stage 3 or 4) were aware of their condition.

Among American youth, newly diagnosed cases of type 1 and type 2 diabetes have significantly increased. For those aged 10--19 years, incidence of type 2 diabetes remained stable among non-Hispanic whites and increased for all others, especially non-Hispanic blacks.

In the coming years, those in healthcare will be caring for more patients with diabetes than ever before, and they will need a comprehensive understanding of the medications used for maintaining glycemic control. This program will provide healthcare professionals with the information they need to be familiar with anti-hyperglycemic medications in oral, nasal and injectable forms.

The primary disorder of type 1 and type 2 diabetes is hyperglycemia, elevated blood glucose caused by the absence of insulin production, as in type 1 diabetes, or decreased insulin production and increased insulin resistance, as in type 2 diabetes. There is a direct relationship between the level and duration of hyperglycemia and the incidence of microvascular and macrovascular complications. In addition, the level and duration of hyperglycemia have a negative effect on the progression of diabetes.

Chronic hyperglycemia is the defining characteristic of the disease, it is linked to the microvascular complications of diabetes, such as retinopathy, nephropathy, and neuropathy, and is a contributing factor in the pathogenesis of cardiovascular disease in patients who have diabetes.