A review published online in The Lancet Diabetes and Endocrinology by Australian and US diabetes researchers shows that regions like the Horn of Africa could experience major epidemics of type 2 diabetes if rapid improvements in economic conditions lead to a whole‐sale adaptation of Western lifestyles during the next three to four decades.

Lead author and Director Emeritus at Baker IDI Heart & Diabetes Institute, Professor Paul Zimmet AO says economic factors could determine future trends in rates of diabetes rather than conventional intervention measures.

The paper, 'Diabetes: a 21st century challenge', says establishing which countries will bear the brunt of diabetes in the future and making these regions a priority for prevention is critical to stemming the diabetes epidemic.

Professor Zimmet points to major increases in type 2 diabetes which have occurred in China and Cambodia 40‐50 years after severe famines.

"With some historical perspective, we are starting to see trends in the way environmental disasters such as famine, interact with the genes of a whole population group. This interaction occurs during pregnancy affecting the baby's risk of chronic diseases such as type 2 diabetes, obesity and heart disease, which can show up decades later.

"Research plays a critical role in helping us put the pieces of the jigsaw together and in doing so, help to shape our responses to this most pressing of public health issues," says Professor Zimmet, Chair of the Scientific Programme for the World Diabetes Congress being held in Melbourne this week.

In highlighting some ofthe key challenges that the diabetes epidemic presents, the paper shows how continents such as Africa are facing an expected 110 per cent increase in the number of people with diabetes within the next two decades.

Professor Zimmet says: "The main effect will be in disadvantaged minority ethnic groups and in developing nations, where some of the highest prevalence of diabetes occurs including Indigenous communities, not only in Australia but also New Zealand and Canada."

Explosive increases in rates of type 2 diabetes are particularly evident in countries such as China and India. "We need to learn from these countries which are developing at a very rapid rate," he says. Professor Zimmetis calling for disease prevention to be given the highest priority and says research should be directed at improved understanding of the potential role of determinants such as the maternal environment and other early life factors.