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Macrovascular complications in diabetes consist of 2 basic pathophysiological characteristics such as obstructive atherosclerotic lesions and non-obstructive sclerotic arterial lesions. The patients with former lesions are frequently complicated with postprandial hyperglycemia, insulin resistance, hyperinsulinemia, metabolic syndrome, smoking or high LDL-C concentrations. The latter lesions are usually characterized by diffuse, multi-vessel diseases and typically found in patients with long duration of diabetes and advanced diabetic retinopathy as well as nephropathy. Cardiovascular events or death in diabetes are as equally high as non-diabetic patients with a previous history of ischemic coronary artery diseases in not only Finish study but also Japanese J-ACCES study. It is now very clear that the progression of macrovascular complications in diabetes can be efficiently prevented by a strict multifactorial control of all coronary risk factors including hyperglycemia.

The detrimental effects of a sedentary lifestyle and poor dietary habits are having a significant negative impact on health statistics, with obesity and its attendant risks becoming a major problem in most developed nations, including Japan. Interventions which prevent or delay the development of type 2 diabetes have the potential to reduce the morbidity and mortality associated with the disease and, as a consequence, related healthcare costs. The study conducted to assess whether alpha-glucosidase inhibitor, voglibose could prevent type 2 diabetes developing in high-risk Japanese subjects with impaired glucose tolerance (IGT). 1,780 eligible subjects received standard diet and exercise therapy, and 897 were randomised to receive voglibose and 883 placebo. The study was planned for treatment to be continued until participants developed type 2 diabetes [primary endpoint; determined by bi-annual oral glucose tolerance tests (OG'Ts) as well as fasting blood glucose measured every 3 months] or normoglycaemia or for a minimum of 3 years, subject to the findings of an interim analysis. The interim analysis significantly favoured voglibose and end-of-study report involves individuals treated for an average of 48.1 weeks. Subjects treated with voglibose had a significantly lower risk for the progression to type 2 diabetes than placebo (50/897 vs 106/881: hazard ratio 0.595). Also, significantly more subjects in the voglibose group achieved normoglycaemia compared with those in the placebo group (599/897 vs 454/881: hazard ratio 1.539). Voglibose, in addition to standard care with diet and exercise, was effective in preventing the progression of IGT to type 2 diabetes and in increasing the proportion of individuals with normoglycaemia in high-risk Japanese subjects with IGT.

Several epidemiological studies show that obesity is a major primary health problem and an independent risk factor for type II diabetes, cardiovascular diseases, and hypertension. Increasing evidence indicates that altered secretion of adipocytokines such as adiponectin, tumor necrosis factor alpha, monocyte chemoattractant protein-1 and free fatty acids are contributing factors to insulin resistance in obese states. Especially, visceral obesity is strongly associated with insulin resistance rather than subcutaneous adipose tissue. Body weight reduction by lifestyle intervention is reported to reduce the risk for developing type II diabetes.

The remarkable feature of glucose metabolisms in older subjects is that 2h plasma glucose concentration (2h-PG) increases linearly with age, but fasting plasma glucose concentration (FPG) does not. 2h-PG is a better predictor of the risk of mortality from cardiovascular disease (CVD) than FPG in older age as well as in young and middle age. Even subjects with isolated impaired glucose tolerance have a two times higher risk of CVD than those with normal glucose tolerance. Thus, the use of fasting glucose alone for diabetes diagnosis may fail to identify older adults at high risk for CVD and they should be evaluated by oral glucose tolerance test.