Mortality Trends and Cardiovascular Complications in Diabetes

Diabetes remains a leading cause of premature death worldwide, driven largely by its impact on the cardiovascular system. Over recent decades, improvements in glycaemic control, lipid management and blood pressure regulation have contributed to declines in cardiovascular mortality among people with both type 1 and type 2 diabetes in many high-income settings. Nonetheless, absolute mortality rates remain elevated compared with non-diabetic populations, and gains have been unevenly distributed by age, sex, ethnicity and socioeconomic status. Furthermore, the burden of diabetic kidney disease and other organ-specific complications has continued to rise in some regions, offsetting progress in vascular outcomes. In parallel, the coexistence of multiple long-term conditions—ranging from hypertension and depression to coronary heart disease—has emerged as a potent determinant of life years lost, especially when such comorbidities manifest at younger ages. This complex interplay of metabolic, vascular and psychosocial factors underpins global disparities in survival and highlights the need for integrated prevention and management strategies tailored to local health-system capacities.

Research from Nature Portfolio

Recent work has quantified the cumulative effect of coexisting conditions in people with diabetes, demonstrating that each additional long-term condition at midlife is associated with several years of life lost. Large-scale population analysis revealed that hypertension, depression, cancer and coronary heart disease make the greatest contributions to community-level loss of life years in older adults with diabetes, whereas mental health disorders and respiratory comorbidities have a disproportionate impact when they occur earlier in adulthood. These findings establish a detailed life-course perspective on how multiple comorbidities accelerate mortality and emphasise the importance of prioritising preventive measures and co-management models that address both metabolic and non-metabolic contributors to mortality.

Mortality Trends and Cardiovascular Complications in Diabetes publication trend

The graph below shows the total number of articles in mortality trends and cardiovascular complications in diabetes across all publications each year (not limited to Nature Index journals).

Technical terms

Cardiovascular disease (CVD): A group of disorders of the heart and blood vessels, including coronary heart disease, stroke and heart failure.

All-cause mortality: The rate of death from any cause in a defined population over a specified period.

Diabetic kidney disease (DKD): Progressive kidney damage resulting from long-term diabetes, often manifesting as albuminuria and reduced glomerular filtration.

Multi-long-term conditions (MLTCs): Co-occurrence of two or more chronic health conditions in the same individual, such as diabetes plus hypertension or depression.

Age-standardised mortality rate (ASMR): A mortality rate adjusted to a standard age distribution, enabling comparisons across populations with different age structures.

References

1. The burden of diabetes-associated multiple long-term conditions on years of life spent and lost. Nature Medicine (2024).
2. Incidence of stroke, subsequent clinical outcomes and health care resource utilization in people with type 2 diabetes: a real-world database study in France: “INSIST” study. Cardiovascular Diabetology (2024).
3. Diabetes mortality: trends and multi-country analysis of the Americas from 2000 to 2019. International Journal of Epidemiology (2024).
4. Trends in hospitalization for cardio‐renal disease and mortality in people with type 1 diabetes in England, 2009–2019. Diabetes Obesity and Metabolism (2024).