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Review
. 2025 Feb 14;5(1):42.
doi: 10.1038/s43856-025-00742-9.

Multiple long-term conditions as the next transition in the global diabetes epidemic

Edward W Gregg  1   2 , Naomi Holman  3   4   5 , Marisa Sophiea  4 , Shivani Misra  6   7 , Jonathan Pearson-Stuttard  4   8 , Jonathan Valabhji #  5   7   9 , Kamlesh Khunti #  10
Affiliations
Review

Multiple long-term conditions as the next transition in the global diabetes epidemic

Edward W Gregg et al. Commun Med (Lond). .

Abstract

Several transitions, or new patterns and dynamics in the contributors and health outcomes, have altered the character and burden of the multi-decade, worldwide growth in prevalence of type 2 diabetes (T2DM). These changes have led to different needs for prevention and care. These dynamics have been driven by diverse demographic, socio-economic, behavioural, and health system response factors. In this Perspective, we describe these transitions and how their attributes have set the stage for multimorbidity, or multiple long-term conditions (MLTCs), to be the next major challenge in the diabetes epidemic. We also describe how the timing and character of these stages differ in high-, middle-, and low-income countries. These challenges call for innovation and a stronger focus on MLTCs across the spectrum of cause, effectiveness, and implementation studies to guide prevention and treatment priorities.

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Conflict of interest statement

Competing interests: S.M. has received speaker Honoraria from Lilly and Sanofi, UK. K.K. has acted as a consultant, speaker or received grants for investigator-initiated studies for Astra Zeneca, Bayer, Novo Nordisk, Sanofi-Aventis, Servier, Lilly and Merck Sharp & Dohme, Boehringer Ingelheim, Oramed Pharmaceuticals, Pfizer, Roche, Daiichi-Sankyo, Applied Therapeutics, Embecta and Nestle Health Science. J.P.S. is a Partner at Lane Clark & Peacock LLP and Chair of the Royal Society for Public Health and reports consultancy fees from Novo Nordisk outside of this work. J.V. was the National Clinical Director for Diabetes and Obesity at NHS England from April 2013 to September 2023 and currently is the National Clinical Lead for Multiple Long Term Conditions at NHS England.

Figures

Fig. 1
Fig. 1. Summary of major transitions in the global diabetes epidemic, as experienced by high income countries, 1960–2020.
The figure describes key patterns in prevalence, incidnece, complications, care, and socio-demographic factors affecting the T2DM pandemic. T2DM: Type 2 diabetes mellitus; DM: diabetes mellitus; SES: socio-economic status; MLTC: multiple long-term conditions
Fig. 2
Fig. 2. Primary drivers of the population-level increase in MLTC prevalence associated with type 2 diabetes.
The figure describes key factors affecting population-level rates and trends in MLTCs. T2DM: Type 2 diabetes mellitus; MLTC: multiple long-term conditions
Fig. 3
Fig. 3. The relationship of age-dependent risk and the development of multiple long-term conditions associated with type 2 diabetes.
Figure is hypothetical and not drawn from a specific population or data set. However, the estimates of median and 25th percentiles in the distribution of age at diagnosis are based on data from the US National Diabetes Surveillance System. The estimates of change in average age of death are based on published modelled estimates that are also based on US national data. T2DM: Type 2 Diabetes Mellitus.
See this image and copyright information in PMC

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