Metabolic and genetic characterization of prediabetic states. Sequence of events leading to non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM)' is pheno- typically heterogenous and may therefore not be explained by one simple pathophysiological mechanism. Despite the heterog- enous nature of the disease, the major form as discussed in this review is linked to overweight, arterial hypertension, dyslipidemia, and macroangiopathy (coronary heart disease), all condi- tions which become more common with aging (1). This form of NIDDM seems to be growing worldwide in the footsteps of Westernized life style. Around 3% in the Western world suffers from the disease, but in subjects 60 yr and older, the prevalence is as high as 10-20% (2). In certain ethnic populations as the Pima Indians and the Nauruans the prevalence approaches 40% (2). Therefore, NIDDM imposes an enormous burden on the health care system all over the world.