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Global trends in diabetes complications: a review of current evidence

  • Jessica L. Harding
  • Meda E. Pavkov
  • Dianna J. Magliano
  • Jonathan E. Shaw
  • Edward W. Gregg


In recent decades, large increases in diabetes prevalence have been demonstrated in virtually all regions of the world. The increase in the number of people with diabetes or with a longer duration of diabetes is likely to alter the disease profile in many populations around the globe, particularly due to a higher incidence of diabetes-specific complications, such as kidney failure and peripheral arterial disease. The epidemiology of other conditions frequently associated with diabetes, including infections and cardiovascular disease, may also change, with direct effects on quality of life, demands on health services and economic costs. The current understanding of the international burden of and variation in diabetes-related complications is poor. The available data suggest that rates of myocardial infarction, stroke and amputation are decreasing among people with diabetes, in parallel with declining mortality. However, these data predominantly come from studies in only a few high-income countries. Trends in other complications of diabetes, such as end-stage renal disease, retinopathy and cancer, are less well explored. In this review, we synthesise data from population-based studies on trends in diabetes complications, with the objectives of: (1) characterising recent and long-term trends in diabetes-related complications; (2) describing regional variation in the excess risk of complications, where possible; and (3) identifying and prioritising gaps for future surveillance and study.


Complications (all) Epidemiology Review Trends 



Acute myocardial infarction


Age-standardised mortality rates


Cardiovascular disease


Diabetic ketoacidosis


End-stage renal disease


Hyperglycaemic hyperosmolar state


Instrumental activities of daily living


Lower-extremity amputation


United States Diabetes Surveillance System



The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The interpretation and reporting of the ESRD data supplied by the United States Renal Data System (USRDS) are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.

Contribution statement

JLH contributed to the literature search and data analyses and interpretation and wrote the manuscript. MEP contributed to the literature search and data analyses and interpretation and reviewed the manuscript. DJM and JES contributed to interpretation of data and reviewed the manuscript. EWG contributed to interpretation of data and writing of the manuscript. All authors approved the version to be published.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2018_4711_MOESM1_ESM.pptx (621 kb)
ESM (PPTX 621 kb)


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Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Jessica L. Harding
    • 1
  • Meda E. Pavkov
    • 1
  • Dianna J. Magliano
    • 2
    • 3
  • Jonathan E. Shaw
    • 2
  • Edward W. Gregg
    • 1
  1. 1.Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC)AtlantaUSA
  2. 2.Department of Clinical Diabetes and EpidemiologyBaker Heart and Diabetes InstituteMelbourneAustralia
  3. 3.School of Population Health and Preventive MedicineMonash UniversityMelbourneAustralia

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