Management of type 2 diabetes: now and the future.

There are about 4.7 million people living with diabetes mellitus in the UK and 90% have type 2 diabetes mellitus (T2DM). This burden will only get worse as there are currently about 12.3 million more at risk of T2DM. Moreover, up to 30% of diagnosed patients already have eye, foot, kidney or nerve complications. This impacts the NHS considerably as it spends about £10 billion annually on diabetes (80% on complications alone). Atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in diabetes, contributes significantly to this. Therefore, there is significant emphasis on the prevention of T2DM especially in at-risk groups with the setting up of initiatives like the Diabetes Prevention Programme. When prevention fails, it is essential to commence glucose-lowering agents to reduce the burden of disease, prevent associated complications and improve quality of life. A patient-centred approach is required to ensure efficacy of treatment strategies and the presence of co-morbidities such as cardiovascular and renal disease should be considered.