Type 2 diabetes, generally perceived as progressive and incurable, now affects 5-10% of the population, about 3.2 million people in the UK. Until complications develop, most patients are managed entirely within primary care, with diabetes comprising a major part of general practice activity. About 10% of total UK NHS expenditure goes on treating diabetes, and international figures suggest that medical costs for people with diabetes are twofold to threefold greater than the average for age and sex matched people without diabetes.
Application of current clinical guidelines to reduce glycated haemoglobin (HbA1c) levels and cardiovascular risks, primarily with drugs and generic lifestyle advice, has improved clinical outcomes, but many patients still develop vascular complications, and life expectancy remains up to six years shorter than in people without diabetes. The diagnosis carries important social and financial penalties for individuals, as well as poor health prospects.