Changing epidemiology of type 2 diabetes mellitus and associated chronic kidney disease

Journal name:
Nature Reviews Nephrology
Year published:
Published online


Chronic kidney disease (CKD) is a common comorbidity in patients with type 2 diabetes mellitus (T2DM) and both conditions are increasing in prevalence. CKD is estimated to affect ~50% patients with T2DM globally, and its presence and severity markedly influences disease prognosis. CKD is more common in certain patient populations, including the elderly, those with youth-onset diabetes mellitus, those who are obese, certain ethnic groups, and disadvantaged populations. These same settings have also seen the greatest increase in the prevalence of T2DM, as exemplified by the increasing prevalence of T2DM in low-to- middle income countries. Patients from low-to-middle income countries are often the least able to deal with the burden of T2DM and CKD and the health-care facilities of these countries least able to deal with the demand for equitable access to renal replacement therapies. The increasing prevalence of younger individuals with T2DM, in whom an accelerated course of complications can be observed, further adds to the global burden of CKD. Paradoxically, improvements in cardiovascular survival in patients with T2DM have contributed to patients surviving longer, allowing sufficient time to develop renal impairment. This Review explores how the changing epidemiology of T2DM has influenced the prevalence and incidence of associated CKD across different populations and clinical settings.

At a glance


  1. Global incidence of type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD).
    Figure 1: Global incidence of type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD).

    High rates of T2DM and ESRD are found in many regions worldwide14, 124. a | Global prevalence of T2DM in adults aged 25–79 years by regions. The highest prevalence of T2DM is seen in the Middle East and North Africa. b | Estimated incidence of ESRD in patients with T2DM by regions. The highest estimated incidence of ESRD in T2DM is found in East Asia and the Pacific. ppm, patients per million.

  2. High background prevalence of renal impairment in the general population, especially in elderly individuals.
    Figure 2: High background prevalence of renal impairment in the general population, especially in elderly individuals.

    a | Prevalence of renal impairment in non-diabetic white Americans from the NHANES III study. b | Prevalence of renal impairment in non-diabetic individuals from the Australian population AUSDIAB study14, 37, 72, 124. Renal impairment is defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2.


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  1. Baker IDI Heart & Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.

    • Merlin C. Thomas,
    • Mark E. Cooper &
    • Paul Zimmet


M.C.T. researched the data for the article. M.C.T. and P.Z. provided substantial contribution to discussions of the content and contributed equally to writing the article. All authors contributed equally to review and/or editing of the manuscript before submission.

Competing interests statement

M.C.T. has received honoraria for educational meetings conducted on behalf of Abbvie, Boehringer–Ingelheim, Eli-Lilly, Merck Sharpe and Dohme, Servier, Novartis, Takeda, Abbot, Allergan, and AstraZeneca. P.Z. has acted as an adviser and received honoraria for speaking on behalf of Eli-Lilly, Novo Nordisk, Haptocure (Israel), Janssen Cilag, and Sanofi Aventis. M.E.C. has received honoraria and consulting fees from Abbvie, Bayer, Boehringer–Ingelheim, Eli-Lilly, Merck, Servier, Takeda, Novo-Nordisk, and AstraZeneca as well as research grants from Novo-Nordisk and Abbvie.

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  • Merlin C. Thomas

    Professor Merlin Thomas is an NHMRC senior research fellow, physician, and scientist working at the Baker IDI Heart and Diabetes Institute, Melbourne, Australia. He is a specialist in nephrology and endocrinology with a special research interest in chronic kidney disease associated with diabetes mellitus, its epidemiology and management.

  • Mark E. Cooper

    Professor Mark Cooper is the Chief Scientific Officer of the Baker IDI Heart and Diabetes Institute and Director of the JDRF Centre for Diabetes Complications at the Baker IDI Heart & Diabetes Institute. He holds honorary appointments as a Professor of Medicine at both Monash University and University of Melbourne. He is a trained endocrinologist with an appointment at the co-located Alfred Hospital.

  • Paul Zimmet

    Professor Paul Zimmet is emeritus director of the Baker IDI Heart and Diabetes Institute and founding director of the International Diabetes Institute before its merger with the Baker IDI Institute. He is an Adjunct Professor at Monash University, is a Patron of Obesity Australia, and Honorary President of the International Diabetes Federation. He is a member of the WHO expert panel on diabetes mellitus.

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