Trying to manage diabetes is hard because if you don’t, there are consequences you’ll have to deal with later in life. — Bryan Adams

The Global Burden of Disease, Injuries, and Risk Factors Study of 2021 estimated that there are 529 million people living with diabetes mellitus (DM) worldwide.¹ Over the next 30 years this number is expected to grow to 1.3 billion. These sobering numbers are considerably higher than estimated in the past.

The incidence of DM is highest in Africa and the Middle East, followed closely by South America and the Caribbean. Diabetes and its complications are substantial burdens to the health care system, with an estimated global cost of $966 billion. Importantly, DM represents the 8^th leading cause of death and disability.¹

Type 2 diabetes makes up 96% of cases.¹ Because the main risk factor for type 2 diabetes is high body mass index (BMI), treatment of this epidemic is not only possible, but relatively doable. One of the biggest hurdles is the fact that most diabetic patients are from lower economic backgrounds, and fast food or processed meals are easier and cheaper than home-cooked meals.

Diabetic retinopathy (DR) incidence rates are notoriously underestimated because many patients never visit an eyecare professional. Meta analyses estimate DR prevalence of 35% among patients with DM.² The rate goes up with male sex, higher HbA_1c, diabetes duration, insulin use, and higher blood pressure levels. In addition, Mexican Americans and African Americans have dramatically higher rates than the White population.² To aid in early diagnosis and management, artificial intelligence algorithms combined with easy-to-use cameras may improve our ability to find these patients in the future. We explore these new devices and software in this issue.

The only current treatments for prevention of DR are intravitreal injections of anti-VEGF agents or steroids, but they are rarely used largely due to the treatment burden and rapid regression back to baseline levels when injections stop. Many companies are working to change the idea that we cannot treat DR using numerous approaches ranging from pills to eye drops to subcutaneous injections. We explore the battle to reduce this epidemic in this issue.

Although the world is witnessing an alarming rise in diabetes and its associated complications, technological advancements and medical innovations bring hope. The combined efforts of society, health care professionals, and policymakers are paramount to ensure early detection, effective management, and affordable treatment options for all. The road ahead is challenging, but with collective perseverance and continuous innovation, a healthier future is within reach. RP

REFERENCES

1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023;402(10397):203-234. doi:10.1016/S0140-6736(23)01301-6
2. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556-564. doi:10.2337/dc11-1909RP