Looking Forward: The next transition in the evolving global diabetes epidemic

The increasing global prevalence of Type 2 Diabetes (T2D) combined with the co-factors of decreasing CVD mortality, early onset and greater heterogeneity of T2D have set the stage for the next transition of the diabetes epidemic, with multimorbidity or multiple long-term conditions (MLTCs) representing the next major challenge.

What does this challenge means for research and public health programmes going forward?

It is important to understand the essential role of future research and innovation in health services research, epidemiology, and implementation research to facilitate an effective population health response to the MLTC challenge.

A perspective article on this next challenge within the global diabetes epidemic was published by Professor Edward Gregg, Head of RCSI’s School of Population Health and Dr Naomi Holman, Research Fellow at Converge: Centre for Chronic Disease and Population Health Research in Nature Communications Medicine.

The global pandemic of T2D has been complex and multi-phasic in its growth over the last 60 years. Underlying the overall increases in prevalence have been several transitions across distinct periods of the diabetes epidemic that impacted the burden and approaches to care, prevention, and research. These transitions have been driven by diverse demographic, socio-economic, behavioural, and health system response factors.

The impact of these transitions and the increasing prevalence of T2D have set the stage for multimorbidity or MLTCs, to be the next major challenge in the diabetes epidemic. Multimorbidity has been defined as the co-occurrence of two or more chronic conditions within a single individual, including chronic disease like diabetes, CVD or cancer, a mental health condition and mood disorders, infections of long duration, such as HIV or hepatitis C, frailty or chronic pain, alcohol or substance abuse, and ongoing conditions such as learning disability (NICE). A high prevalence of MLTCs will be an extensive and persistent challenge for care and prevention in the future.

In this perspective, the authors explore the impact of these transitions and rise in MLTCs on morbidity, health services, and approaches to prevent T2D. The authors describe how the timing and character of these stages differ in high, middle-, and low-income countries. These challenges call for innovation and a stronger focus on MLTCs across the spectrum of cause, effectiveness, and implementation studies to guide prevention and treatment priorities.

RCSI researchers collaborated on this work with colleagues in Imperial College London, NHS England and University Leicester in the UK.