If we do nothing to prevent type 2 diabetes then the numbers of people predicted to be affected by diabetes will reach estimated figures, or perhaps more. Doing nothing is clearly not a viable option. The declaration of the Diabetes in Asia meeting in Colombo, Sri Lanka in 2002 (featured in the second edition of the Diabetes Atlas) called for “programmes [for primary prevention] which must be tailored to local circumstances in order to be effective”. These programmes have already commenced in a few countries. The main features of a particularly prominent example, The Programme for the Prevention of Type 2 Diabetes, in Finland are summarized in Table 1.

In economic terms, the consequences of inaction are likely to be disastrous — disastrous for national economic wellbeing, for public health and social services, and for individuals and families. As with most phenomena such as these, the blow will fall particularly heavily on developing countries, on the poor in these countries in particular, and on the poorer sections of the developed countries. In developing countries like India, which has the largest number of people with diabetes, the burden is mainly on families and individuals, who bear the expenses for diabetes treatment. There are indications that the cost of diabetes care is increasing with time. It is indeed, a major healthcare burden for the nation too.

The total sum that will be spent on treating diabetes and its complications and on preventing diabetes in 2007 is estimated to be at least USD232 billion, increasing to over USD302 billion in 2025. In middle-income countries around half of the medical expenditure devoted to diabetes is spent on the treatment of the acute life-threatening effects of the condition such as hyperglycaemia. The remainder is divided between general medical care and the specific measures necessary to identify and treat complications.

While much can be done to improve outcome for individuals and to reduce these costs by the more effective management of the acute phases of the condition and the longer term effects, the most substantial economic benefit is likely to be realized only when the onset of diabetes itself can be prevented or at least substantially delayed. With many of the proven effective treatments for diabetic complications either unavailable or unaffordable in developing countries and in the poorer sections of many developed countries, the benefits of better management of established diabetes may be unrealizable, at least with current resources.

Out-of-pocket expenses for diabetes care are known often to be severe when a member or members of the family is found to have diabetes. A recent re-examination, using the same methodology as the original study   1 , of the amount poorer Indian families who opt for private care have to pay for diabetes care showed that the original proportion of 25% of family income has increased to 34% from 1998 to 2005   2 . The heavy financial burden of diabetes, when added to other aspects such as anxiety, physical pain and loss of livelihood, can be devastating to individuals and families, particularly when state support or personal health insurance is not available.