Current concepts in diabetes mellitus.

Family physicians play a significant role in the management of patients with diabetes. The classification of diabetes has been revised, requiring higher plasma glucose levels for diagnosis. Insulins have been purified, with contamination by proinsulin-like substances now routinely being less than 50 parts per million. As a result of increasing evidence that improved metabolic control is associated with a lower incidence of complications, especially for microvascular complications in patients with insulin-dependent diabetes, a variety of strategies have been developed to improve control. Early experience with frequent injections of insulins and constant infusion systems (pumps) has been favorable, though achievement of lower blood glucose levels is not without risk. Good control in pregnancy is especially critical. Glycosylated hemoglobin has proven to be a useful addition to assessing control. To achieve optimal therapeutic results, diabetes should be viewed as a chronic biomedical disease with major behavioral components.