Therapeutic objectives and their practical achievement in type 2 diabetes

This paper offers a broad but selective account of the context of type 2 di abetes at the start of the new millennium. It outlines the major long-term threats to health and life of people with type 2 diabetes and indicates tha t, while their relative impacts may differ, the burden of the specific "mic rovascular" and the atherosclerotic 'macrovascular" complications of diabet es weigh as heavily on people with type 2 as on those with type 1 diabetes. Correction of hyperglycemia still has a leading role among therapeutic obj ectives in type 2 diabetes, but the concept of the "defence in depth" and t he crucial importance of control of arterial pressure and correction of dys lipidemia - the "bad companions" in diabetes - is stressed. Other defences against tissue and organ failure in diabetes are described, highlighting th e importance of regular, systematic screening for risk factors and early ma nifestations of tissue damage. Broader organizational, social, and economic factors in diabetes care are touched upon and the need for strong alliance s of all concerned parties - care providers, managers, health politicians, and above all informed and motivated people with diabetes themselves - is u nderlined with reference to the World Health Organization/International Dia betes Federation St. Vincent Declaration Initiative in Europe and its recen t 10-year anniversary "Istanbul Commitment" to full implementation of the D eclaration. (C) 2000 Elsevier Science Inc. All rights reserved.