The public health burden of diabetes and the reality of limits.

Improvements in diabetes surveillance, diagnosis, and treatment have, in recent years, heightened awareness of the burden of diabetes and aroused concern about the amount of health care resources that will be necessary to manage this disease effectively in the future. Examination of diabetes from the twin perspectives of economics and public health challenges basic notions of the health care tradition in the Western world: the real-world combination of finite resources and the growing need/demand for health services forces the consideration of limits in the provision of health care. The growing need to rationally allocate limited health care resources poses emotional, potentially divisive questions of science, politics, economics, and ethics that patients and physicians must each address.