1. The concept of Diabetes & CV risk: A lifetime risk challenge Priorities in the management of type 2 diabetes: Past, present and future Sir George Alberti, MD Diabetes UK Chairman Newcastle, United Kingdom Cardio Diabetes Master Class European chapter Munich, Germany May 6-8, 2011 Slide lecture prepared and held by: Presentation topic

2. TYPES OF DIABETES “Diabetes mellitus … manifests itself in two principle clinical forms (a) acute and (b) chronic. Acute diabetes usually occurs in persons under 40 years of age … in children and young adults. Chronic diabetes … occurs as a rule in elderly people … and often in those who are … decidedly obese. Saundby, 1907

3. GROWING RATES OF DIABETES WORLDWIDE 30 million people in 1985 100 million in 1994 200 million in 2003 380 million by 2025 3.8 million deaths per year 30 million people in 1985 100 million in 1994 200 million in 2003 380 million by 2025 3.8 million deaths per year

4. Global projections for the diabetes epidemic: 2007-2025 (millions) IDF Atlas 2006 46.5 80.3 73% 67.0 99.4 48% 10.4 18.7 80% 24.5 44.5 81% 53.2 64.1 21% 28.3 40.5 43% 16.2 32.7 102% World 2007 = 246 million 2025 = 380 million Increase 55% Diabetes Atlas, 3rd edition, IDF 2006

5. The relationship between BMI and the risk of developing type 2 diabetes Type 2 diabetes, the metabolic syndrome and cardiovascular disease in Europe 5 1.0 1.5 4.4 6.7 11.6 21.3 42.1 2.2 2.9 4.3 5.0 15.8 27.6 40.3 54.0 93.2 8.1 10 Women Men 40 70 100 0 <22<2323- 23.9 Body mass index (kg/m 2 ) 24.926.928.930.932.934.9 24-25-27-29-31-33-35+ Risk of type 2 diabetes

6. Android (Apple) vs Gynoid (Pear) Obesity Jean Vague 1947

7. PRIORITIES FOR THE MANAGEMENT OF TYPE 2 DM Early aggressive management of glucose ?start at “prediabetic” levels? Early aggressive management of CVD risk factors

8. PRIORITIES FOR THE MANAGEMENT OF TYPE 2 DM Key Challenges Prevention Behavioural change Cellular and molecular mechanisms Genetic basis?? Stem cell therapy B-cell replacement/regeneration Safe, effective insulin sensitisers Anti-obesity agents CVD prevention

9. THE UNMET NEEDS: TREATMENT Better education Effective behavioural therapy Preservation of B-cell function Specific prevention of complications Better monitoring of control Prevention of cardiovascular disease Societal interventions INDIVIDUALISED THERAPY