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The imperative to prevent diabetes complications: a broadening spectrum and an increasing burden despite improved outcomes

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While the diabetes epidemic continues to gather pace globally, there is cause for both optimism and concern with regard to diabetes complications. A recent Australian study, in which data from a national diabetes registry collected from 1997 to 2010 was interrogated, showed that mortality rates in diabetes are decreasing,1 in line with secular decreases seen globally. Recent overseas data also show that life expectancy in type 1 diabetes is improving, yet the risk of death from any cause or from cardiovascular causes remains at least twofold higher for such patients compared with the general population.2 Thus, mortality outcomes are improving in people with diabetes and, overall, are better aligning with those of the general population. For example, Australian data indicate that between 1997 and 2010, the diabetes-related death rate for all Australians declined by 20%.3

These data, however, relate particularly to older adults, who generally now lose very few years of life due to diabetes. In contrast, in younger adults with type 1 and type 2 diabetes, mortality has remained high compared with age-matched controls.1,4 Further, subgroups including Indigenous Australians, some people born overseas and those living outside major cities of Australia have notably higher…