Future Directions

Around the world, healthcare services face increasing demands from aging populations, with high disease burdens and expensive new ways of managing them. Many new drugs and other health technologies cost considerably more than those they supplant, but may only give a proportionately small health gain. As a result individuals, insurance companies, health maintenance organizations and national health services are forced to take decisions on which new therapies can be afforded for whom.

Post-menopausal women with diabetes derive similar benefits from hormone replacement therapies as women without diabetes. Despite this, women with diabetes represent the group with the lowest frequency of hormone replacement therapy use. This is a result of much scientific controversy about the risks and benefits of this therapy.

Currently, transplantation of whole pancreases results in insulin independence and normalization of glycosylated haemoglobin values for three years in up to 80 percent of recipients. One group of investigators in Edmonton, Canada, has had initial success with the less invasive procedure of islet transplantation. Should this procedure take precedence?

The lack of trained healthcare professionals and of programmes to train them has been cited by many member associations of the International Diabetes Federation (IDF) as the most critical issue hindering the delivery of high quality diabetes education and care. To address this, the IDF Consultative Section on Diabetes Education set out to write a curriculum that could be used in all IDF member countries. This goal has now been achieved. Read more for an overview of the most remarkable features of this new publication.

The insulin pump offers advantages to some people with Type 1 diabetes, freeing them from the chore of administering a number of injections every day. However, the high cost of the pump and the need for careful supervision will limit its use to wealthy patients who can count on sophisticated medical support. This article proposes the use of "beta cell therapy" in order to create surrogate insulin-producing cells.

It all started in 1996, when the European Association for the Study of Diabetes (EASD) published a document entitled 'European Dimension of Diabetes Research'. Since then, enormous progress has been made towards a greater recognition of the relevance of diabetes research at European Union level.

The benefits of cholesterol-lowering therapy in the prevention of cardiovascular disease (CVD) for people with diabetes and high cholesterol levels had already been suggested by sub-group analysis of some earlier studies. However, there was still substantial uncertainty as to what extent cholesterol-lowering therapy could

There is a rapidly rising epidemic of Type 2 diabetes throughout the world. It is particularly severe in developing countries. In 1995, 62% of people with diabetes in the world lived in developing countries. By 2025 this is predicted to rise to more than 75%. In India there are an estimated 25 million people with diabetes, and this will rise to more than 60 million by 2025. One in five people with diabetes in the world will then be Indian. A parallel rise in ischaemic heart disease (IHD) is also projected. Other developing countries will be similarly affected.

In most people who develop diabetes there is a hereditary (genetic) component. However, in nearly all cases the genetic component alone does not cause the diabetes, but interactions with the environment of a person who is genetically susceptible. This is clearly demonstrated by the epidemic of diabetes worldwide. The dramatic increase in figures clearly cannot be accounted for by genetic factors. However, without the genetic susceptibility modern lifestyle changes would have no fertile field on which to exert their dangerous influences.

In 1965, the World Health Organization (WHO) Expert Committee report on diabetes warned of the danger of an emerging diabetes epidemic. At that time, prevalence rarely exceeded 2%. Today, we know that more than 194 million people worldwide have diabetes. In 2025, the number of people with diabetes in the world will exceed 333 million… unless we act now.