Science, medicine, and the future. Non-insulin dependent diabetes mellitus: the gathering storm

A massive increase in the global prevalence of non-insulin dependent diabetes is likely to occur as "Westernisation" of dietary habits and patterns of physical activity becomes more widespread. Advances in molecular and cellular science may provide some useful insights and therapeutic tools to assist in the fight against the severe consequences of this epidemic. These will include the better identification of specific aetiological subtypes of the disease; the identification of new drugs through the better understanding of the biology of insulin secretion and action; and the targeting of therapies to specific subtypes of the disease. In addition, knowledge of the precise mode of action and antidiabetes drugs may facilitate the design of more effective non-pharmacological manipulations; the genetic identification of "high risk" asymptomatic people may allow us to target screening and preventive strategies more effectively; and investigations into the mechanisms that underlie the link between low birth weight and later diabetes should provide new routes towards treatment and prevention. Barriers to the implementation of the global measures required to stem the predicted flood of non-insulin dependent diabetes may prove insuperable, but if we are to have any success, then close collaboration between clinicians, epidemiologists, public health physicians, and laboratory scientists will be essential.