Hyperglycemia unawareness is the term suggested to me (M. Muggeo, personal communication, 1997) to encompass very broadly all of the stages in diabetes mellitus from the onset of any degree of hyperglycemia until the diagnosis is actually made. Diabetes and its handmaiden, obesity, are growing in epidemic proportions in the US and worldwide. In contrast to obesity where the diagnosis is recognized quite early by the patient, the family and the physician, the diagnosis of diabetes may be delayed from 5 to 15 years after its onset1-5. A significant minority of adults, when newly diagnosed with Type 2 diabetes, have definable evidence of macrovascular or microvascular complications. Presumably those same individuals, were we able to examine their cells and organs, would show additional evidence of the complications of diabetes. Likewise, with the recognition that hyperglycemia per se is a very powerful determinant of the complications of diabetes, we suspect that even those people with the delayed recognition of hyperglycemia but without evidence of complications at the time of diagnosis already have sustained some of the underlying damage typical of diabetic complications. This is supported by the finding that in this group of patients, there are those who will have an 'accelerated rate' of onset of diabetic complications2 (relative to patients with Type 1 diabetes where the onset of hyperglycemia is very close to the time of the diagnosis). Our interpretation is that the progress of the disease may not really be especially rapid; rather, the dating of the onset has been incorrect.

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