The current classification of diabetes mellitus identifies a group of patients who have virtually no insulin secretion and whose survival depends on administration of exogenous insulin. This insulin-dependent group (type 1) represents 5–10% of the diabetic population in the USA. Most type 2 diabetics do not require exog-enous insulin for survival, but many need exogenous supplementa-tion of their endogenous secretion to achieve optimum health.
The consensus of the American Diabetes Association is that inten-sive glycemic control and targeting normal or near-normal glucose control associated with comprehensive self-management training should become standard therapy in diabetic patients (see Box: Benefits of Tight Glycemic Control in Diabetes). Exceptions include patients with advanced renal disease and the elderly, because the risks of hypoglycemia may outweigh the benefit of normal or near-normal glycemic control in these groups. In children under 7 years, the extreme susceptibility of the developing brain to incur damage from hypoglycemia contraindicates attempts at intensive glycemic control.