Abstract
Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease driven by a complex interplay of genetic, biological, behavioural and social factors. The epidemiology of T2DM has shifted considerably, largely attributable to increasing obesity rates. Furthermore, T2DM prevalence is increasing in younger people (diagnosis <40 years of age; early-onset T2DM), which is associated with more aggressive disease progression, higher risk factor burden, earlier and more severe complications, and greater lifetime morbidity than later-onset T2DM. T2DM is traditionally associated with a high risk of microvascular and macrovascular complications, although rates of cardiovascular complications have reduced in some high-income countries. Currently, emerging and non-traditional diabetes complications, such as those related to mental health and cognitive function, are being recognized, and people with T2DM increasingly experience multimorbidity and reduced quality of life. Additionally, a growing prevalence of obesity has resulted in high rates of obesity-related complications. Novel therapies and technologies may offer considerable benefit, although socioeconomic disparities may exacerbate barriers to effective prevention and equitable access. The complex nature of T2DM and its comorbidities underscores the urgent need for a person-centred, holistic approach that integrates glucose and weight management with broader attention to comorbidities, 24-h physical behaviours, psychosocial well-being and social determinants of health.
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Acknowledgements
The authors acknowledge M. Savage (Research Associate, Diabetes Research Centre, Leicester, UK), who provided considerable support with collating sections and formatting the final manuscript. The authors also acknowledge C. Franklin (Senior Creative, Diabetes Research Centre, Leicester, UK), who provided considerable support in drafting and amending the original figure concepts.
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M.J.D. and S.L. are co-first authors. Introduction (all authors); Epidemiology (A.P.-T.); Mechanisms/pathophysiology (S.L., J.G. and T.S.); Diagnosis, screening and prevention (T.T.); Management (I.L., S.L., J.G., T.Y., D.R.F., A.P.-T. and M.J.D.); Quality of Life (R.L., J.G. and T.S.); Outlook (D.R.F., J.G. and R.L.); overview of Primer (M.J.D.).
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M.J.D. has acted as a consultant/adviser and speaker for Eli Lilly and Company, Novo Nordisk and Sanofi, has attended advisory boards for AbbVie, Amgen, AstraZeneca, Biomea Fusion, Carmot/Roche, Daewoong Pharmaceutical, Sanofi, Zealand Pharma, Regeneron, GSK and EktaH and as a speaker for AstraZeneca, Boehringer Ingelheim and Zuellig Pharma. She has received grants from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. S.L. is an advisory board member for Novo Nordisk and AstraZeneca, and has served on the speakers’ bureau of Novo Nordisk, Sanofi, Boehringer Ingelheim and AstraZeneca. He has received research funding from Chong Kun Dang and Daewoong Pharma. A.P.-T. performs research and serves as an adviser on behalf of their employer for Abbvie, Corcept, Dexcom, Eli Lilly and Company, Genentech, Medtronic, Novo Nordisk, Regeneron and Roche; there has been no direct or indirect transfer of funds. D.R.F. has served as an advisor to Eli Lilly and Company, Novo Nordisk, Abbott, Medtronic, AstraZeneca and Embecta, has received research support from Eli Lilly and Company and Novo Nordisk, and has received fees for speaking from AstraZeneca, Eli Lilly and Company, Abbott, Medtronic and Novo Nordisk. T.Y. has received investigator-initiated funding from AstraZeneca, contracted research funding from the Reinsurance Group of America and has acted as a consultant for Regeneron. I.L. received research funding (paid to institution) and/or product from Novo Nordisk, Boehringer Ingelheim, Dexcom, Roche, Pfizer and Eli Lilly and Company. I.L. received research-related consulting fees (paid to institution) from Novo Nordisk, advisory/consulting fees and/or other support from Aadvarak Therapeutics, Abbvie, Altimmune, Alveus Therapeutics, Amgen, Antag Therapeutics, AstraZeneca, Bain Capital, Bayer, Betagenon AB, Bioio, Biomea, Boehringer Ingelheim, Boston Scientific, Carmot, Corxel, Cytoki Pharma, Eli Lilly and Company, Genentech, Intercept, Janssen/J&J, Juvena, Keros Therapeutic, Mediflix, Merck, Metsera, Neurocrine, Novo Nordisk, Pfizer, Regeneron, Roche, Sanofi, Shionogi, Skye Bio, Source Bio, Structure Therapeutics, TERNS Pharma, The Comm Group, Verdiva Bio, WebMD and Zealand Pharma. T.T., R.L., T.S. and J.G. declare no competing interests.
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Davies, M.J., Lim, S., Slater, T. et al. Type 2 diabetes mellitus. Nat Rev Dis Primers 12, 13 (2026). https://doi.org/10.1038/s41572-026-00687-w
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DOI: https://doi.org/10.1038/s41572-026-00687-w
