The burden of diabetes

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Type 2 diabetes is a complex chronic disease with increasing microvascular and macrovascular complications imposing a significant public health and economic burden [1]. Even though a number of efficacious treatments are available, suboptimal applications of these in clinical practice has led to gaps in diabetes prevention and management. Barriers for providers include time constraints, forgetfulness, a perception of patients as noncom-pliant, and inadequate knowledge of outcomes from clinical trials. Barriers for patients include inadequate comprehension of the gravity of the disease, little motivation toward prevention of diabetes and its complications, insufficient time, and lack of socioeconomic resources and support [2-4]. The prevalence of diabetes has increased by 61% from 1990 to 2001 with type 2 diabetes accounting for 95% of this increase [5]. The annual cost of the disease is estimated at $132 billion accounting for more than 10% of the United States healthcare expenditure. Moreover, the lifetime risk for developing diabetes among Americans born in year 2000 is 32.8% for men and 38.5% for women [6]. Hence, there is an urgent need to prevent the

* Corresponding author. VACCHCS/UCSF, 2615 East Clinton Avenue, Fresno, CA 93703.

E-mail address: [email protected] (P.C. Deedwania).

onset of diabetes in the high-risk population. This review addresses the evidence of prevention through lifestyle modification, its challenges, and additional means through pharmacologic interventions specifically targeting the renin angiotensin aldosterone system (RAAS) that may reduce the overall public and economic health burden.

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