Future Directions

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Diabetes research caught in the European spotlight

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.

Towards a new approach to lipid disorders in diabetes: the Heart Protection Study

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

Fetal origins of diabetes in developing countries

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.

Understanding diabetes: the genetics

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.

Aetiology of type 2 diabetes: the road to consensus

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.

Diabetic eye disease: how you can watch out for it

Among the most feared diabetes complications are those affecting the eyes. Indeed, diabetes is the leading cause of partial vision loss and blindness in the working age population in many countries. The good news is that it does not have to be so.

Future directions in diabetes care: how soon is now?

The science of diabetes is experiencing dramatic change and the implications for everyone affected by diabetes are enormous. We have good grounds for optimism and real expectations of a 'cure' for Type 1 diabetes in the longer term. This future would release us from the drudgery and risks of living with diabetes, and from the discrimination and social difficulties that go with it. Yet esoteric scientific advances are only part of the story. Each advance precedes the resulting improvements in treatment by many years, and in most parts of the world will seem irrelevant.

Glucagon-like peptide 1: new therapies for Type 2 diabetes

We usually assume that the ups and downs of blood glucose are solely responsible for changes in the release of insulin into the circulation, such as in response to a meal. However, the release of insulin from the pancreas is supported by signals from the alimentary canal (gut). When food is transported from the stomach into the small intestine, from which glucose, fat and proteins are absorbed into the blood, gut hormones are released into the circulation. Around 50%

Homocysteine and cardiovascular complications in diabetes

People with diabetes are prone to cardiovascular disease (CVD). In people with Type 2 diabetes, the rate of heart-related death is two to four times that in people without diabetes. Traditional risk factors for the build-up of cholesterol-rich plaques in the arteries (atherosclerosis), such as high blood pressure, obesity, smoking, and high blood fat levels (dyslipidaemia), are known to increase the cardiovascular risk in people with diabetes. However, other factors may be operative as well.

Bringing advanced therapies to market faster: a role for biosimulation?

In the last 10 years, genomic and proteomic technologies have been applied to identify and develop a new generation of diabetes treatments. While these technologies have become increasingly automated, producing a deluge of potential therapeutic targets and biological insights, projections estimate that individual drug development time and cost will continue to rise and soon exceed 1 billion USD. A significant contributor to this rising cost is the large

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