Diabetes complications have shifted significantly over the past two decades, with traditional microvascular risks like retinopathy being joined by a wave of emerging conditions including dementia, liver disease, and mental health challenges, according to recent public health findings and expert analyses.
Diabetes complications have transformed over the last 20 years and will continue to evolve over the next two decades, according to Professor Dianna Magliano, head of the diabetes and population health research theme at the Baker Heart and Diabetes Institute in Melbourne, who spoke at the International Diabetes Federation Western Pacific Region Congress. Traditionally, these health impacts have been classified into two main categories: microvascular and macrovascular complications.
“The microvascular complications, these are complications which are described as pathognomonic of diabetes, meaning they are directly associated with prolonged hyperglycaemia.”
Professor Dianna Magliano, Baker Heart and Diabetes Institute
Microvascular outcomes include conditions such as retinopathy and neuropathy. Meanwhile, macrovascular complications—which encompass heart failure, myocardial infarction, stroke, and peripheral arterial disease—occur in individuals both with and without diabetes, meaning optimal glucose control offers only partial benefits against them, as Professor Magliano explained during her wide-ranging presentation.
Emerging Conditions and the Rise of Multimorbidity
Advances in drug development and disease management have successfully improved survival rates for people living with diabetes. However, longer lifespans have paved the way for an increasing number of concurrent conditions, shifting the clinical focus toward multiple long-term conditions, also known as multimorbidity. Among the emerging health outcomes now linked to the condition are cancer, infections, functional disability, frailty, liver disease, cognitive disability and dementia, and affective disorders including depression and anxiety, alongside sleep apnea and hearing loss.
Population data illustrates this epidemiological shift clearly. In Australia, the proportion of individuals with diabetes dying from cardiovascular disease dropped from 34% in 2005 to 25% in 2019. Over that same timeframe, however, the proportion of deaths attributed to cancer climbed from 25% to 28%, and deaths linked to dementia surged from 1% to 6%. Similar mortality patterns emerged internationally across Denmark, Sweden, Finland, Scotland, and South Korea, reflecting a broader global transition in how the disease impacts aging populations.
Hospitalisation Trends Reveal Novel Health Burdens
Hospital admission data reinforces this shifting disease profile. While hospitalisations for heart failure, myocardial infarction, and hypoglycaemia have decreased, admissions for hyperglycaemia and amputations have grown. When researchers ranked the top excess causes of hospitalisation among people with diabetes compared to the general population, traditional complications accounted for only half of the top ten.
Photo: Nature
“We took these excess causes of hospitalisations amongst people with diabetes compared to the general population, and we ranked the magnitude of excess annual hospitalisations. We thought the top 10 would all be traditional complications – but they weren’t.”
Professor Dianna Magliano, Baker Heart and Diabetes Institute
The remaining spots on the list featured emerging issues such as depression, pneumonia, and various infections.
The Complex Bidirectional Link Between Diabetes and Mental Health
“The pathways are not really well elucidated, but inflammation is probably going to have a major role. We also know that antipsychotic medications can cause weight gain… and then you might have a higher risk of developing diabetes.”
Photo: Frontiersin
Professor Dianna Magliano, Baker Heart and Diabetes Institute
