Introduction Summary A massive increase in the global prevalence of non-insulin dependent diabetes is likely to occur as “Westernisation” of dietary habits and patterns of physical activity becomes more widespread. Advances in molecular and cellular science may provide some useful insights and therapeutic tools to assist in the fight against the severe consequences of this epidemic. These will include the better identification of specific aetiological subtypes of the disease; the identification of new drugs through the better understanding of the biology of insulin secretion and action; and the targeting of therapies to specific subtypes of the disease. In addition, knowledge of the precise mode of action and antidiabetes drugs may facilitate the design of more effective non-pharmacological manipulations; the genetic identification of “high risk” asymptomatic people may allow us to target screening and preventive strategies more effectively; and investigations into the mechanisms that underlie the link between low birth weight and later diabetes should provide new routes towards treatment and prevention. Barriers to the implementation of the global measures required to stem the predicted flood of non-insulin dependent diabetes may prove insuperable, but if we are to have any success, then close collaboration between clinicians, epidemiologists, public health physicians, and laboratory scientists will be essential. Non-insulin dependent diabetes mellitus affects about 2% of the British population. It is often referred to as “mild” diabetes, but it results in a huge burden of human misery. It is among the commonest causes of blindness in middle aged and elderly people and an important cause of renal failure resulting in the need for dialysis or kidney transplantation. It is the most common condition leading to (non-trauma related) lower limb amputation. In addition, people with non-insulin dependent diabetes have a greatly increased risk of myocardial infarction or stroke, and when these events happen the resulting functional disability is usually greater than that which occurs in non-diabetic people. As if that were not enough, some people with diabetes are made to believe that the development of the disease and their failure to avoid the often devastating consequences are, in some way, their own fault. Not surprisingly, low self esteem and even clinical depression often occur. The beginnings of a worldwide epidemic of non-insulin dependent diabetes are readily discernible. The prevalence of diabetes in South Asian immigrants to Britain, for example, is 20-30% in the 40 to 75 year age group.1 Similar figures are now appearing from studies of migrants from rural to urban areas within less developed countries. By 2020 there will be an estimated 250 million people with non-insulin dependent diabetes in the world.2 Apart from the human suffering, this epidemic will undoubtedly limit the funds available for the treatment and prevention of other diseases in poorer countries. Does scientific research hold out any hope for the effective treatment and, preferably, prevention of this rampant disease? I'm not sure, but in this article I shall examine the possible routes whereby scientific knowledge might be translated into practical benefits. In ascending order of importance these might include increased understanding of the causes of non-insulin dependent diabetes, improved treatments which have beneficial effects on outcome and do not make excessive demands on the patient, and prevention of the disease.