The burden and risks of emerging complications of diabetes mellitus

Abstract

The traditional complications of diabetes mellitus are well known and continue to pose a considerable burden on millions of people living with diabetes mellitus. However, advances in the management of diabetes mellitus and, consequently, longer life expectancies, have resulted in the emergence of evidence of the existence of a different set of lesser-acknowledged diabetes mellitus complications. With declining mortality from vascular disease, which once accounted for more than 50% of deaths amongst people with diabetes mellitus, cancer and dementia now comprise the leading causes of death in people with diabetes mellitus in some countries or regions. Additionally, studies have demonstrated notable links between diabetes mellitus and a broad range of comorbidities, including cognitive decline, functional disability, affective disorders, obstructive sleep apnoea and liver disease, and have refined our understanding of the association between diabetes mellitus and infection. However, no published review currently synthesizes this evidence to provide an in-depth discussion of the burden and risks of these emerging complications. This Review summarizes information from systematic reviews and major cohort studies regarding emerging complications of type 1 and type 2 diabetes mellitus to identify and quantify associations, highlight gaps and discrepancies in the evidence, and consider implications for the future management of diabetes mellitus.

Abstract

This article discusses evidence for the emergence of a different set of complications associated with diabetes mellitus from the traditional ones, outlines the risks and burden of these associated complications and considers implications for the future management of diabetes mellitus.

Key points

• With advances in the management of diabetes mellitus, evidence is emerging of an increased risk and burden of a different set of lesser-known complications of diabetes mellitus.

• As mortality from vascular diseases has declined, cancer and dementia have become leading causes of death amongst people with diabetes mellitus.

• Diabetes mellitus is associated with an increased risk of various cancers, especially gastrointestinal cancers and female-specific cancers.

• Hospitalization and mortality from various infections, including COVID-19, pneumonia, foot and kidney infections, are increased in people with diabetes mellitus.

• Cognitive and functional disability, nonalcoholic fatty liver disease, obstructive sleep apnoea and depression are also common in people with diabetes mellitus.

• As new complications of diabetes mellitus continue to emerge, the management of this disorder should be viewed holistically, and screening guidelines should consider conditions such as cancer, liver disease and depression.