Every 5 seconds someone somewhere in the world is diagnosed with diabetes, and every 10 seconds someone dies of it. As a result of technical and clinical advances, and public health successes such as the lowering of national smoking rates, there has been a dramatic decline in mortality from cardiovascular disease in several developed countries over the past three to four decades. Regrettably, there is no parallel effect for diabetes, which continues toincrease inexorably. It is timely to ponder the extent of the diabetes problem, its implications for development and how these, and the human suffering it imposes, might most successfully be mitigated.