Diabetes: a time for excitement---and concern

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Editorial p 693 Papers pp 703, 713, 720 These are exciting, and exasperating, times for people interested in diabetes. On the one hand, a tremendous volume of research is underway assessing both new prevention and new treatment protocols; on the other, the incidence (and associated mortality and morbidity) of this disease continues to rise with little sign of abating. Indeed, by 2010 the world's diabetic population will probably have doubled from an estimated 110 million in 1994 to 221 million in 2010.1 What have we learnt recently about the epidemiology, causation, and prevention of this condition? Prevalence varies widely by ethnic group and country (adult rates range from <2% in rural Bantu people in Tanzania to nearly 50% in US Pima Indians and South Pacific Naurauns1). Rates are also relatively high in “transplanted populations,” such as Asians in Europe2 and African Americans.3 The projected increase in rates, however, is universal. Though this rise is mainly due to type 2 diabetes, alarming increases in type 1 have also been observed in many studies. For example, a recent report from Allegheny County, USA, showed for the first time that rates for type 1 diabetes in adolescent African Americans now exceed those in whites.4 Whether this relates to an increasing incidence of type 2 diabetes among adolescents and young adults elsewhere is unclear, 5 6 as the distinction between type 1 and type 2 is often …