The economic burden of insulin resistance

Diabetes mellitus has reached epidemic proportions worldwide as we enter th e new millennium. The World Health Organization (WHO) has commented there i s 'an apparent epidemic of diabetes which is strongly related to lifestyle and economic change'. Over the next decade the projected number will exceed 200 million, possibly reaching 250 million persons. Most will have type 2 diabetes and all are at risk of the development of complications. Better ed ucation, improved nutrition, more exercise, early diagnosis and prompt trea tment are imperative. Diabetes is a serious disease, subject to the development of many complicat ions affecting large vessels (heart, cerebral and peripheral), small Vessel s (kidney and retina), nerves and other organs. In type 2 diabetes these co mplications may precede diagnosis of the disease by many years. The process continues inexorably with premature mortality and morbidity mainly from th e development of vascular disease. Data from the WHO confirm the principal role of non-communicable disease on mortality in developed countries, while mortality in developing countries is rising rapidly, now often exceeding c ommunicable disease. The noncommunicable diseases are divided into cancer a nd degenerative diseases. In the developed world, degenerative diseases are grouped to include ischaemic heart disease, stroke, renal failure, hyperte nsion and other macro- and microvascular diseases. The major complications of diabetes encountered most frequently and with th e greatest impact are: 1. Neuropathy: both peripheral and autonomic, with principal manifestations in the lower limbs 2 Microvascular disease, mainly affecting the retina and kidney resulting i n blindness and renal failure 3. Macrovascular disease, presenting with atherosclerosis in the coronary a rteries causing ischaemic heart disease, cerebrovascular disease causing st roke and peripheral vascular disease contributing to diabetic gangrene.