Diabetes

Diabetes mellitus is one of the most common endocrine diseases in all populations and all age groups. It is a syndrome of disturbed intermediary metabolism caused by inadequate insulin secretion or impaired insulin action, or both. Diabetes is crudely grouped into the two types—insulin dependent diabetes mellitus and non-insulin dependent diabetes mellitus. Both types are associated with excessive morbidity and mortality. Relative mortality in people with insulin dependent diabetes is between 10 and 30 (equal to a 5-10 year reduction in life expectancy), depending on the age at diagnosis, current age, the duration of the disease, and the year of diagnosis.1 Although cohorts of patients with insulin dependent diabetes diagnosed after 1955 may have a better prognosis, this trend seems to be levelling off.3 Non-insulin dependent diabetes is associated with an overall age adjusted mortality that is about twice that of non-diabetic populations; life expectancy is reduced by 5 to 10 years in middle aged patients with this type of diabetes.4 There are no signs of a reduction in mortality from non-insulin dependent diabetes.

Diabetes has a serious economic impact. In 1992, the estimated cost of diabetes in the United States was between $85bn and $92bn, two thirds of which resulted from lost productivity because of admission to hospital and death.5 The worldwide prevalence of diabetes is expected to more than double between 1994 and 2010, to 239 million people (fig 1).6 Tight metabolic control, drug treatment of hypertension and hyperlipidaemia, and efforts directed at changes in lifestyle will therefore pose heavy financial burdens on global healthcare systems. Urgent political and organisational decisions need to be made now.