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constitutes about 85% to 95% of all diabetes cases in developed countries
and accounts for an even higher percentage in developing countries.
26
The impact of T2DM is certainly comparable to other diseases of mod-
ern society, such as hypertension and obesity, and often coexists with
these other conditions.

When we think of diabetes we tend to imagine a disease that afflicts af-
fluent, western societies, but increasingly T2DM respects neither wealth
nor social status and the places with the most serious T2DM are coun-
tries such as India (see below). Indeed, almost 80% of diabetes deaths
occur in low- and middle-income countries as these countries often
lack the necessary healthcare resources to manage this disease effec-
tively. These developing countries are also likely to see the largest in-
26
creases in the prevalence of T2DM in the coming years and decades. 26
A silent disease

The epidemiological figures certainly make disturbing reading, but they
are not the whole story. T2DM, especially in its early stages, is a silent
disease. Symptoms, even if they occur, are mild and are easily over-
looked even though hyperglycaemia and the consequences thereof
are insidiously causing damage. At least 50% of all people with diabe-
tes are unaware of their condition and in some countries this figure may
reach 80%.
26
By the time they are diagnosed, a considerable proportion of peo-
ple have already started to develop diabetes-associated complica-
tions, such as retinal abnormalities with a potential to lead to visual
impairment in the long run, initial damage to the kidneys (albuminuria)
eventually threatening kidney function, heart disease, stroke and nerve
damage. Studies suggest that the typical patient with new-onset
26
T2DM has had the disease for at least 4–7 years before it is diagnosed.
27
It seems that undiagnosed T2DM is far from being a benign condition.
27
Clinically significant morbidity is present at diagnosis and for years
before diagnosis. Among people with T2DM, 25% are believed to have
27
retinopathy; 9%, neuropathy; and 8%, nephropathy at the time of
diagnosis. 28
Economic burden

T2DM and its complications (considered later in this chapter) have a
significant economic impact on individuals, families, health systems
and countries. Costs include those for healthcare, loss of earnings, and
economic costs to society in terms of loss of productivity and associ-
ated lost opportunities for economic development. The CODE study
29
revealed that hospitalisations account for 55% of all T2DM expenditure
in Europe. 30

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