I am often guilty of diabetes isolationism. I tend to think about diabetes within a United States vacuum. But diabetes is a worldwide disease. The World Health Organization website identified the worldwide prevalence of diabetes at 171 million in 2000, and projects this number will rise to 366 million in 2030. Unfortunately, diabetes treatment and education is severely lacking in developing countries.

Mexico is one developing country where the public health system is failing the disease. Diabetes is the leading cause of death in Mexico, with 138 deaths per 100,000 adults aged 20 to 84 in 2000. That compares to 82 deaths in 100,000 here in the United States. Mexico also has one of the world's highest prevalence rates -- 10.7 percent of adults 20 to 69 have diabetes.

Half the population in Mexico is medically uninsured. That statistic blew me away. Many Mexican families are unable to afford the most basic tools to manage the disease such as blood glucose meters, lancets, blood test strips, syringes and cotton swabs. Chronic hyperglycemia results in extensive complications such as nerve damage or vision loss. Families become more impoverished as their loved one with diabetes cannot work.

A 12 year study examined three separate definitions of the Metabolic Syndrome and how it can be used to predict major outcomes of diabetes (MOD). In case you were wondering, MOD is the easy way to explain complications like coronary artery disease, renal failure, diabetes-related death, or an aggregate of all of the above.

The study involved 514 type 1 diabetics. The three definitions of Metabolic Syndrome used for the study were taken from: NCEP ATP III (AHA Modified), International Diabetes Federation (IDF), and the World Health Organization (WHO). The prevalence of Metabolic Syndrome ranged from 8% (IDF) to 21% (WHO) at the conclusion of the 12-year follow-up. All definitions showed reasonable specificity (83%) for each outcome, while the WHO definition had the highest sensitivity for all outcomes except Renal Failure, for which eGDR was most sensitive. However, the individual assessment of each complication, rather than an aggregate estimate, was most accurate. Microalbuminuria was clearly the strongest predictor of all individual outcomes.

What an acronym! MOD stands for major outcomes of diabetes, which is far less posh than the vernacular predecessor, mod, which means vanguard in style. But I digress -- praise be microalbuminuria for being crowned the best single predictor of MOD. If you happen to linger with curiosity to learn more about microalbuminuria, indulge in the deep ocean of Wikipedia.