CONCLUSIONS

This booklet highlights some of the many advances in our understanding of diabetes in recent years, and provides an overview of current efforts to develop new medicines for treating this condition. The past decade has seen considerable success in both of these fields.

And yet the burden of diabetes on the community and the health service is also growing rapidly.

• Recent estimates show that the number of people affected by diabetes in the United Kingdom has now exceeded 2,000,000, with more than 1,750,000 diagnosed cases in England alone.
• In addition, a further 750,000 to 1,000,000 people are believed to be affected, but are as yet undiagnosed.
• Globally, the World Health Organisation has estimated that diabetes is likely to be the fifth most important cause of death.

Optimising treatment
There is much to be gained, both financially and in terms of quality and length of life of the individual, from improving treatment of all stages of diabetes - both through new medicines and better use of existing medicines - to prevent the longer-term complications that impose such a high burden of illness and death.

Extensive trials show that strict control of blood glucose and blood pressure, and the use of other medications such as aspirin and statins, are able to reduce significantly the incidence of retinopathy, kidney disease, heart attacks and strokes, which are more common in people with diabetes.

The major public health challenge, now that such evidence of benefit exists, is to ensure that all those who can benefit from it are given optimal treatment.

Expanding diagnosis
It must also be a high priority to identify patients who have not been diagnosed, mainly those with type 2 diabetes, and start treatment in a timely fashion, so that complications have not progressed to an advanced state before medical help is sought.

A pilot project to screen those at high risk for diabetes has been started in 2003 by the NHS in nine inner-city sites outside London. This project is currently in progress, but results have not yet been reported.

Preventing diabetes
The ultimate goal remains to reverse existing trends and minimise the number of people who develop diabetes. This is clearly a huge and long-term task, and not one that can be achieved through medication alone.

In contemplating this enormous goal, three important areas can be distinguished. Given the risk factors and descriptions of the various elements of diabetes discussed in this booklet, these are:

• Preventing progression from pre-diabetes to diabetes
• Treating obesity
• Preventing obesity.

These must involve essential changes in lifestyle. The Finnish Prevention Study has shown clearly that this can be effective in preventing progression to diabetes. There may also be a role for medication. The NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial launched by Novartis in 2001 has prevention of progression as its primary goal and other similar large studies may show some hope of slowing progression.

While treating obesity is another aspect in which medications may well have a role to play, preventing it is the broadest and most difficult challenge. While it will make great demands of each and every member of the public as well as healthcare professionals, it is an essential part of the challenge of defeating diabetes.

The economic and health costs of diabetes are enormous, and escalating. At present, medicines are the principal mainstay of treatment, but public awareness of the vital importance of a healthy lifestyle and a balanced diet could make a real contribution to avoiding and managing diabetes. This booklet has given only a glimpse into the complex science of medical research. The pharmaceutical industry has a key role to play developing innovative and effective new treatments for diabetes - the future will see how we can all benefit from these efforts.