Diabetes?

The scale of the diabetes pandemic is frightening. As well as seeing increasing numbers of patients, many countries are reporting earlier onset of type 2 diabetes and its associated complications. The United Nations has recently adopted a resolution on diabetes and designated November 14th World Diabetes Day. Lifestyle modification remains the cornerstone of preventive and management strategies, however, it is usually not associated with sustained benefit. Clinicians need more and better drugs in their therapeutic armamentarium. The release of drugs in the incretin class of gut peptide-related compounds is welcome; the withdrawal of inhaled insulin from the market within a few months of its launch is frustrating. Enthusiasm for the use of new pharmacological agents earlier in the course of type 2 diabetes needs to be tempered by concerns about long-term safety of these agents. While the ability of a drug to impact on a surrogate outcome like preservation of beta-cell function is encouraging, it needs to be followed up by studies assessing long-term (mainly cardiovascular) outcomes.