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Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities

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A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 20 September 2026 | Viewed by 14493

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Dr. Kinfe G. Bishu

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Guest Editor

1. Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Health Care System, Charleston, SC 29401-5799, USA
2. College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
Interests: diabetes; chronic kidney disease; stroke; epilepsy; substance use disorder; cost–benefit; health disparities; health service research; health economics

Dr. Joni S. Williams

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Guest Editor

Health Equity Research, Medical College of Wisconsin, Milwaukee, WI, USA
Interests: type 2 diabetes; cardiovascular disease risk factors; health equity and health disparities; social-medical integration; chronic disease self-management; social determinants of health

Special Issue Information

Dear Colleagues,

Diabetology is an international, open access journal. In this Special Issue of Diabetology, we invite researchers to submit their works on topic of "Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities”. The instructions on how to proceed with writing will be available on a dedicated web page. Research areas may include (but are not limited to) the following:

Epidemiology of diabetes, presenting the latest data on the incidence, prevalence and risk factors across different populations.
Diabetes’ associations with a range of acute and chronic complications that significantly impact patients' quality of life and healthcare resources.
The economic burden of diabetes on individuals, healthcare systems and society at large, including areas such as healthcare utilization, costs and cost-effectiveness.
Disparities in diabetes’ prevalence, care, and other outcomes across different populations, influenced by social determinants/socioeconomic status and geographic regions, or efforts to reduce these inequities.

We invite you to submit original research articles, systematic reviews, narrative reviews or short communications on this topic. We look forward to your contributions.

Dr. Kinfe G. Bishu
Dr. Joni S. Williams
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diabetology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

prevalence
risk factors
complications
mortality
healthcare utilization
healthcare costs
cost-effectiveness
social determinants
health disparities

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Published Papers (8 papers)

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Research

Jump to: Review

18 pages, 624 KB

Open AccessArticle

Validation of Prostate Cancer Diagnosis and Cause of Death in a National Cohort of Male Veterans with Type 2 Diabetes

by Kinfe G. Bishu, Andrew D. Schreiner, David J. Taber, Matvey Tsivian and Mulugeta Gebregziabher

Diabetology 2026, 7(8), 158; https://doi.org/10.3390/diabetology7080158 - 17 Aug 2026

Viewed by 209

Abstract

Background: Accurate diagnosis and cause of death ascertainment are essential for effective disease surveillance and epidemiological research. This study aimed to validate prostate cancer diagnostic accuracy (PCa) and the accuracy of cause of death information among veterans with type 2 diabetes mellitus (T2DM). Methods: We conducted a retrospective cohort study of veterans with T2DM diagnosed during the baseline period (2008–2009) and followed from 2010 to 2019 using data from the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW). Diagnostic codes and cause of death data were obtained from the Prostate Cancer Data Core (PCDC) and the National Death Index (NDI), which served as the gold standards for validating PCa diagnosis and mortality information in the CDW. Concordance between data sources was assessed using Cohen’s Kappa statistic. Results: Among 763,424 veterans with T2DM, 37,048 (4.9%) were diagnosed with PCa in the CDW and 36,861 (4.8%) in the PCDC, with a concordance rate of 36,361 (98.6% of patients diagnosed in the PCDC). Mortality data from the NDI identified 2723 deaths with PCa listed as the underlying cause of death, of whom 75.4% had a corresponding PCa diagnosis recorded in the CDW. For all-cause mortality, 328,165 veterans were identified as deceased in the CDW Vital Status File (VSF), compared with 326,707 deaths recorded in the NDI. Of these, 324,567 deaths were concordant between the two sources, representing 99.3% of NDI-recorded deaths. Compared with the PCDC, the CDW demonstrated high accuracy for identifying incident PCa diagnosis, with a sensitivity of 98.6% and a specificity of 99.9%. Conclusions: The findings demonstrated a high level of concordance in key outcomes, including PCa diagnosis between the CDW and PCDC, and all-cause mortality between the CDW VSF and NDI. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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16 pages, 786 KB

Open AccessArticle

Cardiometabolic Burden and Diabetes Medication Acquisition Among Adults with Diagnosed Diabetes in Peru: A National Survey Analysis, 2022–2024

by Víctor Juan Vera-Ponce and Jhosmer Ballena-Caicedo

Diabetology 2026, 7(6), 117; https://doi.org/10.3390/diabetology7060117 - 17 Jun 2026

Viewed by 536

Abstract

Background/Objectives: Contemporary diabetes guidelines increasingly emphasize broader cardiometabolic risk stratification beyond glycemic control, but the national proportion of Peruvian adults with diagnosed diabetes who show obesity or hypertension is unknown. We estimated the prevalence of overweight/obesity, obesity, and hypertension; quantified the proportion meeting at least one cardiometabolic-profile criterion; and described recent acquisition of diabetes medications. Methods: We performed a cross-sectional analysis of the Peruvian Demographic and Family Health Survey (ENDES) 2022–2024. Adults aged ≥30 years with a prior medical diagnosis of diabetes were included (n = 2599; weighted population estimate = 1.51 million) from 49,363 eligible adults (weighted population estimate = 19.91 million). Survey-weighted prevalences of overweight (body mass index [BMI] ≥ 25 kg/m²), obesity (BMI ≥ 30 kg/m²), hypertension (primary definition: systolic blood pressure [SBP] ≥ 140 mmHg or diastolic blood pressure [DBP] ≥ 90 mmHg), and diabetes medication purchase in the previous 12 months were estimated. Results: Mean age was 60.0 years (95% confidence interval [CI]: 59.2–60.8), and 55.9% were women. Overall, 81.5% (95% CI: 79.2–83.7) had overweight/obesity, 41.1% (95% CI: 38.0–44.3) had obesity, and 31.8% (95% CI: 28.7–34.9) had hypertension by the primary survey definition. Among participants with complete data for obesity and hypertension (n = 2534; weighted population estimate = 1.45 million), 58.5% (95% CI: 55.4–61.6) met at least one cardiometabolic-profile criterion. Independently, 78.9% (95% CI: 76.4–81.3) reported purchasing diabetes medications, with lower proportions in rural populations and among uninsured adults. Conclusions: Nearly six in ten Peruvian adults with diagnosed diabetes had obesity or hypertension, a population-level profile consistent with substantial cardiometabolic complexity and the potential need for broader risk-oriented management beyond glucose alone. Persistent gaps in medication acquisition suggest that therapeutic modernization and equitable continuity of basic pharmacologic treatment should be addressed simultaneously. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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20 pages, 598 KB

Open AccessArticle

Association of Social Determinants of Health with Primary and Cost-Related Medication Nonadherence Among Adult Patients with Diabetes

by Yamini Mallisetty, Shruti Chaudhary, Ashley W. Ellis, Rushin Shah and Satya Surbhi

Diabetology 2026, 7(5), 86; https://doi.org/10.3390/diabetology7050086 - 2 May 2026

Viewed by 1112

Abstract

Background/Objectives: To examine the association of social determinants of health (SDOHs) with primary and cost-related medication nonadherence among adults with diabetes. Methods: A retrospective cross-sectional analysis was conducted using 2021 data from the Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the United States civilian noninstitutionalized population. Adults aged ≥ 18 years with a diagnosis of diabetes in 2021 were included. The outcomes include primary medication nonadherence (no antidiabetic prescriptions filled) and cost-related medication nonadherence (delaying prescriptions due to cost). The exposure variables include SDOHs such as financial stress, food insecurity, transportation barriers, social support, access to medical care in the neighborhood, and healthcare discrimination. Weighted multivariable logistic regression analyses were conducted to assess the association between SDOHs and medication nonadherence. Results: Among 21.9 million patients with diabetes, 6.5% reported cost-related nonadherence and 17.4% exhibited primary nonadherence. Difficulty paying rent or mortgage (OR 2.32, 95% CI: 1.27–4.23), food insecurity (OR 2.13, 95% CI: 1.27–3.58), and transportation barriers (OR = 2.15; 95% CI: 1.20–3.63) were significantly associated with cost-related nonadherence. In the Medicare subgroup, both difficulty paying rent or mortgage (OR = 2.41, 95% CI: 1.03–5.64) and food insecurity (OR = 2.16, 95% CI: 1.18–3.96) significantly increased cost-related nonadherence. Conclusions: Financial strain, food insecurity, and transportation barriers are associated with cost-related nonadherence. These findings suggest considering social and economic factors in strategies supporting diabetes medication adherence across populations, including Medicare beneficiaries. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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11 pages, 940 KB

Open AccessArticle

Effect of Glycemic Management on Severity of Functional Impairment in Elderly Individuals with Type 2 Diabetes

by Kohei Ueda, Rie Saito, Akiko Matsunaga, Takayuki Sonoda, Misako Kawaguchi, Saori Kaeriyama, Satsuki Sato, Yasuo Zenimaru, Masamichi Ikawa and Norio Harada

Diabetology 2026, 7(4), 74; https://doi.org/10.3390/diabetology7040074 - 3 Apr 2026

Viewed by 1370

Abstract

Background/Objectives: Diabetes threatens independent living among elderly individuals. However, the effects of glycemic management on the severity of functional impairment are unclear. This study aimed to elucidate the relationship between glycemic management and functional impairment severity in elderly individuals with type 2 diabetes (T2D). Methods: We used data from the Japanese National Health Insurance Database from 2017 to 2024. The database included 11,411 elderly individuals (≥65 years) with Long-Term Care Insurance evaluations. Functional status was classified into three categories based on independence—Group A (non-mild impairment), Group B (moderate impairment), and Group C (severe impairment). The factors associated with the severity of functional impairment in patients with T2D were elucidated. Results: The severity of functional impairment was significantly greater in patients with T2D than in those without T2D. In participants with T2D, low glycated hemoglobin (HbA1c) levels were associated with the severity of functional impairment (odds ratio [OR]: 0.78; p < 0.001). In contrast, the use of antidiabetic drugs that could induce severe hypoglycemia (high-risk drugs) was positively associated with the severity of functional impairment (Group A vs. B/C: OR: 1.42; p < 0.001; Group C vs. A/B: OR: 1.90; p < 0.001). The frequency of high-risk drug use increased as functional impairment increased. Conclusions: The use of high-risk drugs is associated with the severity of functional impairment in elderly individuals with T2D. Elucidating the factors associated with the severity of functional impairment in elderly individuals with T2D may contribute to maintaining their quality of life and reducing the economic burden on healthcare and long-term care systems. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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15 pages, 446 KB

Open AccessArticle

Impact of Cumulative Social Determinants of Health on Odds of Diabetes Incidence in US Veterans

by Lewis J. Frey, Mulugeta Gebregziabher, Kinfe G. Bishu, Brianna Youngblood, Jihad S. Obeid, Jianlin Shi, Patrick R. Alba and Chanita Hughes Halbert

Diabetology 2026, 7(2), 37; https://doi.org/10.3390/diabetology7020037 - 11 Feb 2026

Viewed by 1317

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic condition that has been attributed to social factors; however, the cumulative effect of social determinants of health (SDOH) on T2DM incidence is not known. Objective: The aim of the present study was to examine the association between T2DM and the cumulative burden of multiple SDOH. Design: The study is a retrospective cohort study with a baseline between 2008 and 2009 and a ten-year follow-up between 2010 and 2019. Setting: The study was conducted using data from the United States Veterans Health Administration (VHA). Participants: Out of 10,537,027 patients treated in the VHA between 2010 and 2019, 6,518,102 patients were selected who had no evidence of T2DM or Elixhauser comorbidities at baseline (2008–2009). Measurements: Over 10 years following baseline, the exposure consisted of seven types of SDOH occurring in structured data: social isolation, financial stress, employment issues, food insecurity, transportation insecurity, unstably housed, and psychosocial need. Incidence of T2DM in the ten-year follow-up window was the primary outcome. Results: Veterans with ≥3 SDOH doubled their adjusted odds of T2DM (2.07; CI: 2.05–2.09). There were significant racial differences in cumulative SDOH, with 8.8% of Black individuals having the highest burden of ≥3 SDOH compared with 3.8% of White individuals. Transportation insecurity, psychosocial need, and financial stress significantly increased the odds of T2DM across all racial and ethnic groups. Black individuals had the highest T2DM odds ratio for psychosocial need (OR = 1.58; CI: 1.56, 1.60). Limitations: The Veteran population is predominantly male, limiting generalization to the wider population. Conclusions: With each additional SDOH burden, the odds of T2DM increased, and ≥3 SDOH doubled the odds. The cumulative SDOH burden and associated disparities warrant investigation to reduce T2DM incidence. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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17 pages, 674 KB

Open AccessArticle

Effectiveness of a Community-Based Health Care Program on Glycemic Control Among Patients with Uncontrolled Type 2 Diabetes Mellitus: A Quasi-Experimental Study

by Patcharin Phuwilert, Supatra Noo-In, Chitkamon Srichomphoo, Jirarat Ruetrakul, Ruchakron Kongmant and Santisith Khiewkhern

Diabetology 2026, 7(1), 14; https://doi.org/10.3390/diabetology7010014 - 6 Jan 2026

Cited by 2 | Viewed by 2136

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem in Thailand, particularly in rural areas where individuals have limited access to structured diabetes care and education. Poor self-management contributes to uncontrolled glycemic levels and long-term complications. Objectives: This study evaluated the effectiveness of a community-based health care program on glycemic control and self-care behaviors among adults with uncontrolled T2DM. Methods: A quasi-experimental study was conducted among 80 patients with uncontrolled T2DM in Kalasin Province. Participants were assigned to either an intervention group (n = 40) or a comparison group (n = 40). The 12-week intervention consisted of diabetes self-management education, individualized lifestyle support, and community/family engagement. Diabetes self-care behavior and glycated hemoglobin (HbA1c) were assessed at baseline and Week 12. Statistical analyses included paired t-test, independent t-test, and 95% confidence intervals. Results: The intervention group demonstrated a significant improvement in self-care behavior (MD = 14.83; p < 0.0001), compared with a minimal change in the comparison group (0.80; p = 0.756). HbA1c levels significantly decreased in the intervention group (−0.47%; 95% CI: −0.61 to −0.33; p < 0.0001), while a slight nonsignificant increase was observed in the comparison group (0.11%; p = 0.210). The between-group analysis showed a significant reduction in HbA1c favoring the intervention (−0.92%; p < 0.0001), supported by a large effect size (Hedges’ g = 0.87). Conclusions: This community-based health care program effectively enhanced diabetes self-management behaviors and improved glycemic control. Integrating such behavioral support into primary health care services may strengthen long-term diabetes management and reduce complications among patients with uncontrolled T2DM. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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35 pages, 2576 KB

Open AccessArticle

A Study on Risk Factors Associated with Gestational Diabetes Mellitus

by Isabel Salas Lorenzo, Jair J. Pineda-Pineda, Ernesto Parra Inza, Saylé Sigarreta Ricardo and Sergio José Torralbas Fitz

Diabetology 2025, 6(10), 119; https://doi.org/10.3390/diabetology6100119 - 17 Oct 2025

Cited by 1 | Viewed by 3295

Abstract

Background/Objectives: Gestational Diabetes Mellitus (GDM) is a global health issue with immediate and long-term maternal–fetal complications. Current diagnostic approaches, such as the Oral Glucose Tolerance Test (OGTT), have limitations in accessibility, sensitivity, and timing. This study aimed to identify key nodes and structural interactions associated with GDM using graph theory and network analysis to improve early predictive strategies. Methods: A literature review inspired by PRISMA guidelines (2004–2025) identified 44 clinically relevant factors. A directed graph was constructed using Python (version 3.10.12), and centrality metrics (closeness, betweenness, eigenvector), k-core decomposition, and a Minimum Dominating Set (MDS) were computed. The MDS, derived using an integer linear programming model, was used to determine the smallest subset of nodes with systemic dominance across the network. Results: The MDS included 20 nodes, with seven showing a high out-degree (≥4), notably Apo A1, vitamin D, vitamin D deficiency, and sedentary lifestyle. Vitamin D exhibited 15 outgoing edges, connecting directly to protective factors like HDL and inversely to risk factors such as smoking and obesity. Sedentary behavior also showed high structural influence. Closeness centrality highlighted triglycerides, insulin resistance, uric acid, fasting plasma glucose, and HDL as nodes with strong predictive potential, based on their high closeness and multiple incoming connections. Conclusions: Vitamin D and sedentary behavior emerged as structurally dominant nodes in the GDM network. Alongside metabolically relevant nodes with high closeness centrality, these findings support the utility of graph-based network analysis for early detection and targeted clinical interventions in maternal health. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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Review

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12 pages, 784 KB

Open AccessReview

High Diabetes Prevalence and Implications for Progress Toward SDG 3: An Umbrella Review of Four African Countries

by Addisu Tadesse Sahile, Mussie Wubshet Teka and Azwihangwisi Helen Mavhandu-Mudzusi

Diabetology 2026, 7(5), 97; https://doi.org/10.3390/diabetology7050097 - 18 May 2026

Viewed by 814

Abstract

Background: Diabetes mellitus (DM) is an emerging public health challenge in Africa, driven by rapid urbanisation, changing lifestyles and socio-economic transitions. As the global prevalence rises, evidence on the burden and determinants of DM across African countries remains fragmented and inconsistent. Objective: We aimed to synthesize evidence from existing systematic reviews and meta-analyses on the prevalence and determinants of diabetes mellitus across African populations, thereby informing targeted interventions and policy actions. Methods: This umbrella review followed the PRISMA guidelines and included systematic reviews and meta-analyses of studies, published up to December 2024, that reported on DM prevalence and/or risk factors for DM in adults across four African countries. The literature was retrieved from PubMed, Scopus, Web of Science and African Journals Online (AJOL). Quality assessment was conducted using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, version 2) tool, and only moderate- to high-quality reviews were retained. Random-effects models were used to estimate the pooled prevalence and odds ratios (ORs), while heterogeneity, publication bias and sensitivity analyses were also conducted. Findings: Seven reviews were included, covering four countries: Ethiopia, South Africa, Nigeria and Ghana. The pooled prevalence of diabetes mellitus was 9.0% (95% CI: 6.0–12.0%), with significant heterogeneity (I² = 99.8%). Among the determinants, only family history of DM (OR:5.11, 95% CI: 2.96–8.85), hypertension (OR: 2.52; 95% CI: 1.65–3.83), obesity (OR: 3.04; 95% CI: 1.92–4.82), physical inactivity (OR: 3.32; 95% CI: 1.99–5.54), smoking (OR: 2.59; 95% CI: 1.23–5.47), unhealthy diet (OR: 4.77; 95% CI: 1.73–13.18) and urban residence (OR: 5.81; 95%CI: 4.41–7.65), showed a statistically significant association. Sensitivity analysis confirmed the robustness of pooled prevalence, and no significant publication bias was detected. Conclusions: Diabetes mellitus prevalence in Africa is rising and approaching the global averages. The heterogeneity in risk factors underscores the need for localised, context-specific strategies. Full article

(This article belongs to the Special Issue Advances in Diabetes: Prevalence, Risk Factors, Complications, Costs and Disparities)

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