Diabetic Complications: Current Challenges and Opportunities

The International Diabetes Federation estimates that 366 million people had diabetes in 2011, and that by 2030, this figure will have risen to a staggering 552 million worldwide. In 2011, diabetes was the cause of 4.6 million deaths and accounted for 11 % of adult healthcare expenditure in the USA [1]. The increasing incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) elevates the complications of diabetes as one of the most important current public health issues. Complications of diabetes range from acute, life-threatening conditions such as severe hypoglycemia or ketoacidosis to chronic, debilitating complications affecting multiple organ systems, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Estimates of the prevalence of diabetic complications are challenging, in part because there are no internationally agreed upon standards for diagnosis. However, a vast majority of those with diabetes will experience one of more of these complications of diabetes. For example, a recent analysis by the META-EYE study group reported that 93 million people worldwide suffer from diabetic retinopathy. For those with 20 or more years of diabetes, three quarters have some form of diabetic retinopathy [2]. This special issue focuses on progress and challenges in basic and clinical research on these chronic complications of diabetes. The end-stage consequences of diabetic complications can include severe vision loss; end-stage renal disease necessitating dialysis or transplant; myocardial infarction and stroke; and amputations. Many of these life-threatening or disabling events can be preventable with proper " lifelong " diabetes care and a healthy lifestyle. The risk of complications is linked to the duration of diabetes and the degree of glycemic control achieved, most commonly assessed by measuring glycated hemoglobin, or HbA1c, a measure of glycemic control over a course of 2 to 3 months. It should be noted that susceptibility to complications varies among individuals with diabetes, and in some cases, complications develop even in those with lower HbA1c values, ostensibly reflecting good glycemic control. Cardiovascular disease (CVD) is a major cause of mortality in diabetes. In addition to an increased incidence of CVD compared to the general population, people with CVD and diabetes fare more poorly compared to those without diabetes [3]. The prevalence of cardiovascular risk factors in young people with diabetes is of particular concern [4]. The worldwide increase in obesity not only contributes to the increase of T2D, but also exacerbates overall risk of complications in those with T1D, …