Diabetes has emerged as one of the most significant non-communicable diseases worldwide, with rapidly increasing prevalence across high-, middle-, and low-income countries. Once considered a condition of affluence, it now disproportionately affects disadvantaged populations.

This episode examines:

• Global epidemiology of type 1 and type 2 diabetes• Pathophysiology of insulin deficiency and insulin resistance• The metabolic syndrome and clustering of risk• Obesity, diet, and physical inactivity• Urbanisation and nutritional transition• Early-life programming and intergenerational risk• Complications - cardiovascular disease, nephropathy, neuropathy, retinopathy• Health system burden and long-term management• Prevention through population-level interventions

Type 2 diabetes represents the intersection of biology and environment. Genetic susceptibility interacts with calorie-dense diets, reduced physical activity, and social determinants of health. The result is a chronic condition that demands sustained health system engagement.

The episode explores the life-course trajectory of metabolic risk and the importance of prevention strategies that operate beyond individual clinical care - including food systems, urban planning, and fiscal policy.

Diabetes is not merely a disorder of glucose regulation. It is a marker of structural change.

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Key Takeaways

• Diabetes prevalence is increasing globally• Type 2 diabetes is strongly linked to modifiable environmental factors• Early detection reduces long-term complications• Prevention requires structural and policy interventions• Complications drive substantial morbidity and health expenditure• Intergenerational risk transmission is increasingly recognised• Equity considerations are central to effective diabetes control

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