Diabetes mellitus and cardiovascular disease. Pandora's box has been opened.

As a result of an aging, increasingly obese, and decreasingly physically active population, the global incidence and prevalence of type 2 diabetes mellitus (DM) is increasing. While little can be done to influence the contribution of aging to the increasing global prevalence of diabetes, opportunities abound to develop effective interventions with regard to diet, exercise and obesity to prevent type 2 DM and more importantly, diabetes-associated complications. The major cause of morbidity and mortality from diabetes is from atherosclerotic macrovascular disease-including peripheral, cerebrovascular, and coronary artery disease. The markedly increased risk for cardiovascular disease associated with diabetes compound medical and public health challenges in the face of the burgeoning global epidemic of diabetes and will inevitably strain healthcare resources. Although the cardiovascular benefits of glycemic control have yet to be clearly established, a number of therapeutic interventions improve cardiovascular risk among the high-risk cohort of patients with diabetes. The development of new strategies targeting both primary prevention of diabetes and the prevention of diabetic complications will remain important research and clinical objectives. Great advances are being made in the realm of diabetes and cardiovascular disease, and there is much optimism for the future.