The burden of diabetes and its complications: trends and implications for intervention.

Much of the burden of diabetes is due to the development of vascular complications, including cardiovascular diseases, retinopathy and nephropathy. Improvements in patient management to promote tight control of glycaemia have helped to reduce the prevalence of microvascular complications, but cardiovascular diseases continue to be the leading cause of death in patients with type 2 diabetes. Globally, the number of people with diabetes is predicted to almost double over the next 30 years, with much of this increase occurring in developing countries. The growing prevalence of obesity is the major factor driving the increasing prevalence of type 2 diabetes, and the increase in obesity in adolescents is of particular concern. Consequently, the overall number of people with the vascular complications of diabetes is also predicted to increase. Prevention of diabetes is the best strategy for reducing the risk of complications, and screening of high-risk individuals is already being promoted in some countries. Lifestyle changes, focusing on diet, exercise and weight loss are effective in preventing diabetes in such people. However, more information is required about the long-term sustainability of these changes, and programmes also need to be adapted to meet the needs of developing countries.