The global burden of diabetes mellitus (DM) is the theme of this week’s Lancet. Four-fifths of the 225 million diabetic patients live in developing countries and type 2 DM is the most common form. The major cause of morbidity and mortality is coronary heart disease (CHD). Tight control of glucose in diabetic patients has a proven benefit for microvascular disease (retinopathy, nephropathy and neuropathy) [1]. However, the existing trials have not consistently shown a benefit for macrovascular disease (coronary heart disease, or CHD, and stroke) [2].