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Clinical Review

Science, medicine, and the future Non-insulin dependent diabetes mellitus: the gathering storm

BMJ 1997; 314 doi: (Published 29 March 1997) Cite this as: BMJ 1997;314:955
  1. Stephen O'Rahilly, professor of metabolic medicinea,
  2. John Savill, Series editora
  1. University of Cambridge Departments of Medicine and Clinical Biochemistry Addenbrooke's Hospital Box 157 Cambridge CB2 2QR



    A massive increase in the global prevalence of non-insulin dependent diabetes is likely to occur as “Westernisation” of dietary habits and patterns of physical activity becomes more widespread. Advances in molecular and cellular science may provide some useful insights and therapeutic tools to assist in the fight against the severe consequences of this epidemic. These will include the better identification of specific aetiological subtypes of the disease; the identification of new drugs through the better understanding of the biology of insulin secretion and action; and the targeting of therapies to specific subtypes of the disease. In addition, knowledge of the precise mode of action and antidiabetes drugs may facilitate the design of more effective non-pharmacological manipulations; the genetic identification of “high risk” asymptomatic people may allow us to target screening and preventive strategies more effectively; and investigations into the mechanisms that underlie the link between low birth weight and later diabetes should provide new routes towards treatment and prevention. Barriers to the implementation of the global measures required to stem the predicted flood of non-insulin dependent diabetes may prove insuperable, but if we are to have any success, then close collaboration between clinicians, epidemiologists, public health physicians, and laboratory scientists will be essential.

    Non-insulin dependent diabetes mellitus affects about 2% of the British population. It is often referred to as “mild” diabetes, but it results in a huge burden of human misery. It is among the commonest causes of blindness in middle aged and elderly people and an important cause of renal failure resulting in the need for dialysis or kidney transplantation. It is the most common condition leading to (non-trauma related) lower limb amputation. In addition, people with non-insulin dependent diabetes have a greatly increased risk of myocardial infarction or stroke, and when these events happen the resulting functional …

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