Therapeutic objectives and their practical achievement in type 2 diabetes

This paper offers a broad but selective account of the context of type 2 diabetes 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 that, while their relative impacts may differ, the burden of the specific "microvascular" and the atherosclerotic "macrovascular" complications of diabetes 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 objectives in type 2 diabetes, but the concept of the "defence in depth" and the crucial importance of control of arterial pressure and correction of dyslipidemia - the "bad companions" in diabetes - is stressed. Other defences against tissue and organ failure in diabetes are described, highlighting the importance of regular, systematic screening for risk factors and early manifestations of tissue damage. Broader organizational, social and economic factors in diabetes care are touched upon and the need for strong alliances of all concerned parties - care providers, managers, health politicians, and above all informed and motivated people with diabetes themselves - is underlined with reference to the World Health Organization/International Diabetes Federation St. Vincent Declaration Initiative in Europe and its recent 10-year anniversary "Istanbul Commitment" to full implementation of the Declaration.