Full research paper The global epidemics of diabetes in the 21st century: Current situation and perspectives Eberhard Standl 1 , Kamlesh Khunti 2 , Tina Birgitte Hansen 3 and Oliver Schnell 1 Abstract Diabetes is on the rise worldwide, with a global prevalence in adults in 2017 being 8.8% of the world population, with the anticipation of a further increase to 9.9% by 2045. In total numbers, this reflects a population of 424.9 million people with diabetes worldwide in 2017, with an estimate of a 48% increase to 628.6 million people by 2045. Depending on age, global diabetes prevalence is about 5%, 10%, 15% and close to 20%, respectively, for the age groups 35–39, 45–49, 55–59 and 65–69 years. On a global scale, diabetes hits particularly ‘middle aged’ people between 40 and 59 years, which causes serious economic and social implications. Furthermore, diabetes affects especially low and middle income countries, as 77% of all people with diabetes worldwide live in those countries. In addition to overt diabetes, an estimated 352.1 million people worldwide are at risk of diabetes, i.e. have defined pre-diabetes, a figure which is anticipated to rise to 531.6 million by 2045. Some 70–75% of all patients with established coronary artery disease, e.g. with acute myocardial infarction, show concomitant diabetes or abnormal glucose regulation, i.e. close to 50% have overt diabetes, with as many as 20% of those being undiagnosed and another 25% having pre-diabetes. Keywords Diabetes prevalence, pre-diabetes prevalence, oral glucose tolerance test, cardiovascular risk Received 8 July 2019; accepted 17 September 2019 Introduction Diabetes mellitus can affect people in many ways, ran- ging from acute threats due to decompensated metab- olism with severe hyperglycaemic hyperosmolar coma, ketoacidosis, or severe hypoglycaemia, to longer-term serious complications at the large and small arterial blood vessels as well as at the nervous system, and to lifelong challenges to the quality of life due to a whole array of psychosocial problems. 1 Both the United Nations and the World Health Organization (WHO), therefore, have focused on diabetes as a major global health concern in view of the enormous worldwide epi- demic of this, perhaps the most important non-commu- nicable global disease fostered by an unhealthy modern lifestyle. 2,3 In terms of cardiovascular risk, diabetes and cardiovascular disease have been described as ‘two bad companions’ or the two sides of the same coin, with the majority of people with diabetes dying from cardiovas- cular causes and, vice versa, the majority of contempor- ary people with cardiovascular complications also having diabetes or pre-diabetes. 1,4–6 Accordingly, joint guidelines have been launched first by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) 4,5 and fol- lowed by other interdisciplinary health organisations worldwide. 7 The present paper gives a brief overview of the current and expected future global burden of diabetes mellitus as part of a supplement issue of this journal dedicated to the topic ‘diabetes and cardiovas- cular risk’. 1 Forschergruppe Diabetes eV at Munich Helmholtz Centre, Germany 2 Diabetes Research Centre, University of Leicester, UK 3 Department of Cardiology, Zealand University Hospital, Denmark Corresponding author: Eberhard Standl, Forschergruppe Diabetes eV at Munich Helmholtz Centre, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany. Email: Eberhard.Standl@lrz.uni-muenchen.de European Journal of Preventive Cardiology 2019, Vol. 26(2S) 7–14 ! The European Society of Cardiology 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/2047487319881021 journals.sagepub.com/home/cpr