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The prevalence of diabetes mellitus (DM) is very high worldwide. According to the World Health Organization (WHO), in 2000 the worldwide prevalence of DM was 171,000,000. In 2005, the WHO estimated that by 2030 the worldwide prevalence of diabetes will reach 366,000,000 [1]. End-stage renal disease (ESRD) second-


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Behrooz Broumand, MD

Iran University of Medical Sciences

7 Daroogar Alley, Mehmanoost St., Farmanieh Ave.

Tehran 19549 (Iran)

Tel. +98 21 2228 3658, Fax +98 21 8872 1141, E-Mail [email protected]

Fig. 1. The incident counts and adjusted incidence rates by primary diagnosis in ESRD patients according to the USRDS.

Year Year

Fig. 1. The incident counts and adjusted incidence rates by primary diagnosis in ESRD patients according to the USRDS.

ary to advanced diabetic nephropathy (DN) requiring renal replacement therapy (RRT) is one of the most serious complications of DM. According to the 2005 United States Renal Data System (USRDS) estimates, the number of patients suffering from DN and ESRD who are admitted to dialysis units is increasing dramatically. The incidence of reported ESRD was 4.3% with type-1 DM and 40.5% with type-2 DM [2]. Figures 1 and 2 reveal the incidence and prevalence of DM in dialysis according to the USRDS. The incidence of patients with DN requiring dialysis is globally significant. 36 and 22% of incident dialysis patients in Germany and Australia, respectively, have ESRD due to DN [3]. This figure is no less in developing countries, for instance in Iran 25.2% of incident dialysis patients are reported to have ESRD as a result of DN [4]. Figure 3 shows the incidence of RRT according to different registries [5]. Indeed it can be claimed that many developed and developing countries are in the midst of an epidemic of ESRD. Part of this epidemic can be explained by the increase in life expectancy that has occurred worldwide in the past two centuries [6]. Currently the effect of general health improvement is more pronounced in developing countries. For example in Iran, a country which is considered to be a medium human development country, the life expectancy at birth increased to 70.1 years in 2002. As a result, the total population has increased from 33.4 million in 1975 to 68.1 million in 2002. In Pakistan which is considered to be a low human development country, the total population in

1975 was 70.3 million, and in 2002, it increased to 149.9 million. These figures for countries with high human development, e.g. Belgium, have changed less dramatically; the population was 9.8 million in 1975 and 10.3 million in 2002. In the USA the population grew from 220.2 million in 1975 to 291.0 million in 2002 [7]. The remarkable population growth which is being observed in developing countries is a welcome consequence of decreased mortality during infancy and young adulthood, better nutrition and the control of infections, and improved education. An unwanted consequence of these improvements has been the emergence of chronic metabolic diseases including ESRD. It can be concluded from this fact that, in the third millennium, the global epidemic of ESRD will be of importance worldwide and more importantly in develop -ing countries. This fact may not be quite evident as the prevalent worldwide ESRD data are reported from patients who are undergoing maintenance hemodialysis (MHD). In developing countries, the number of patients reaching dialysis is dramatically less than the number of patients who die before reaching dialysis. Another major problem in the developing world is the lack of reliable statistics regarding the incidence and prevalence of diseases, morbidity, and mortality.

Even for the developed countries, providing enough funds for management of RRT has not been easy, and certainly for the developing countries, it is a dream. These facts impact the fate of diabetics in the dialysis unit and elsewhere. Indeed it is very hard to improve the fate of any

Fig. 2. Prevalent count and adjusted rates by primary disease according to the USRDS 2005 annual data report.

Year Year

Fig. 2. Prevalent count and adjusted rates by primary disease according to the USRDS 2005 annual data report.

disease in the presence of poverty. Even if newer technology becomes cheaper in the future, the scarcity of funds, wealth and infrastructure in the underdeveloped world will be a barrier to changing the fate of the diabetic patient.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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