Non-insulin-dependent diabetes mellitus (NIDDM) is NIDDM cases in the population are undiagnosed. This means that many people already have complications of a common disorder which is underdiagnosed, often undertreated and has long existed in the shadow of the the disease when they present clinically. The UKPDS reported that half of newly diagnosed NIDDM subjects more dramatic insulin-dependent variety. To redress this balance and to put NIDDM in a proper perspective, the already had one or more complication, 5 and up to onethird may have retinopathy. The specific complications British Diabetic Association recently commissioned the Kings Fund to report on the situation. This Report has (retinopathy, nephropathy and neuropathy) are common in NIDDM. NIDDM is the commonest cause of visual now appeared under the title 'Counting the Cost: The Real Impact of Non Insulin Dependent Diabetes'. 1 It is impairment through maculopathy, and also cataract.
Similarly, NIDDM is a major cause of renal failure. timely and represents an important contribution to the literature. Hopefully, it will once and for all dispel the Diabetes accounts for one-quarter of those entering renal replacement therapy 6 and the majority of these have misapprehension that NIDDM is 'mild' diabetes.
NIDDM affects an estimated 110 million people NIDDM. Contrary to earlier beliefs, patients with NIDDM run just as great a risk of developing renal failure as worldwide. 2 Good population based data on prevalence are few in the UK but the report indicates a figure of 3 IDDM subjects. Neuropathy is also a common cause of morbidity in NIDDM. to 5 % in the over-20s. In Newcastle we found 2.9 and 3.6 % in the over-25 male and female population
The specific complications, although important, pale by comparison with macroangiopathy. As pointed out respectively. 3 Similar figures are available in many other European populations. The prevalence rises sharply with in the Kings Fund Report, CVD is the major cause of death in NIDDM and the major cause of premature age to more than 10 % in the over-65s. One alarming feature is that the prevalence appears to be increasing mortality. There is a greater than twofold increase of all atherosclerotic complications (heart disease, stroke, and all over the world. Zimmet and McCarty 2 estimate a global number of 216 million by 2010. This is contributed symptomatic peripheral arterial disease) compared with the non-diabetic population even when allowing for all to by demographic changes, i.e. the ageing of the population, but even within the elderly the prevalence other known risk factors. This risk is even greater for ischaemic heart disease in South Asians and for stroke is rising. The prevalence is also higher in certain ethnic groups. Thus, in South Asians from the Indian sub-in Afro-Caribbeans. The combination of neuropathy and peripheral vascular disease also leads to the problems continent figures of 20 to 30 % have been reported in the 40 to 75 year old age group. We have found even of the diabetic foot and amputations, well described in the Report. it is clear, therefore, that NIDDM is not benign higher figures in the South Asians with 20 % of over 25 years olds having NIDDM. In Afro-Caribbeans almost as and is associated with major morbidity and mortality.
After this excellent and well-balanced account of high a prevalence has been found.
Thus, as emphasized by the Kings Fund Report, NIDDM and its complications, the Report continues with informative and telling chapters on the organisation of NIDDM is common and becoming commoner. This of itself emphasizes the emergence of NIDDM as a major care for people with NIDDM, and the costs of dealing with the disorder. Historically in the UK diabetes was public health issue-and it is sad that NIDDM was 'short-listed' for the Health of the Nation list but did not cared for in hospital clinics but with grossly inadequate staffing and checks on quality. In many hospitals, appear amongst the final priority areas. More important, however, are the sequelae of NIDDM, the so-called moreover, diabetic people were treated by general physicians and the major focus was on IDDM. This specific and non-specific complications of diabetes.
Unlike IDDM, much NIDDM remains undiagnosed. situation has changed dramatically in the last 10 to 15 years. The number of consultant diabetologists has Figures for the USA suggest that, on average, people have had the disorder for about a decade before the increased dramatically, particularly in the last five years, but more important has been the advent of specialist diagnosis is made. 4 At any one time probably 50 % of diabetes nurses. As the report states, by 1990 86 % of districts had such nurses. In Newcastle the first diabetes