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1. Introduction
Diabetes mellitus is one of the most significant public health problems. The number of patients with diabetes is increasing due to population growth and a growing prevalence of physical inactivity leading to obesity.[1] In 1985, approximately 30 million people were reported to have diabetes worldwide.[2] A decade later, this estimate had reached 140 million.[3] In 2003, the global prevalence of diabetes was estimated to be 250 million.[3] Including undiagnosed cases of diabetes, this number is expected to reach 438 million by 2030 (approximately 7.5% of the adult population).[1,3,4] There seems to be no region of the world that will not be affected by the disease. While some of this increase will be observed in Australia, Europe and North America, the majority will be seen in countries undergoing westernization (the African continent, South America, China, India and the Middle East).[1] The majority of diabetic patients are between 45 and 65 years of age in developing countries, while they are ≥65 years of age in developed countries.[3,5] Although type 2 diabetes was previously considered to be a chronic disease of middle and late adulthood, it is increasingly becoming prevalent in adolescents.[6] The number of deaths attributable to diabetes has been estimated at around 3 million per year, which is approximately 5% of global mortality.[7]
Two types of diabetes predominate in the population. Type 1 diabetes is characterized by an inability of the body to produce insulin, whereas type 2 diabetes reflects deficient insulin secretion and/ or insulin resistance (approximately 90% of all cases of diabetes).[8] Some patients are difficult to classify as having type 1 or 2 diabetes, thus other specific types of the disease have been described (e.g. gestational diabetes, malnutrition-related diabetes, etc.). Gestational diabetes represents a separate entity as do other specific types of diabetes associated with genetic defects, diseases of the exocrine pancreas (i.e. pancreatitis, cancer or cystic fibrosis), drug- or chemical-induced, infection-related or immune-mediated diabetes. Risk factors for diabetes are anthropometric factors (e.g. obesity), metabolic factors (e.g. parameters of glucose metabolism), lifestyle factors (e.g. physical activity), metabolic syndrome, age, sex and ethnicity.[9] Most people with type 2 diabetes are obese and the degree of duration of obesity correlates with the risk of the diabetes. Obesity and inactivity are two of...