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There are an estimated 246 million people with diabetes in the world, of whom about 80% reside in developing countries.1 India is the country that currently has the largest number of people with diabetes (40.9 million), and this number is expected to increase to 69.9 million by the year 2025.1 The most disturbing trend is a shift in age of onset of diabetes to a younger age in recent years. This presents a serious challenge to the healthcare system because, at the peak of their working career, people with diabetes have an excess risk of mortality and morbidity compared with those without diabetes.2–4 Indeed, over two-thirds of deaths attributable to diabetes occur in developing countries.5 Asian Indians with diabetes also have higher mortality than people with diabetes from other ethnic groups.6
Although diabetes is often not recorded as the cause of death, globally, it is believed to be the fifth leading cause of death in 2000 after communicable diseases, cardiovascular disease, cancer and injuries.7 Moreover, it is associated with other disease conditions such as coronary artery disease, which are subsequently recorded as the cause of death. According to a WHO study, there are about five times as many deaths indirectly attributable to diabetes.8 A report published by the Indian Council of Medical Research (ICMR) in 2004 shows that, in India, diabetes accounts for 109 000 deaths/year.9 WHO estimated that, in 2005, mortality from diabetes, heart disease and stroke cost about 210 billion …
Competing interests: None.