The rapidly increasing incidence of type 2 diabetes and macrovascular and microvascular complications disproportionately affects younger age groups: A decade of evidence from an international federated database

To characterise recent trends in incidence and prevalence of type 2 diabetes (T2D) associated complications, and their relative impact across the lifespan. We conducted a retrospective cohort study using the TriNetX global federated database. Incidence and prevalence of T2D and associated complications: ischaemic heart disease (IHD), heart failure, cerebral infarction, neuropathy, nephropathy, and retinopathy were assessed between 2012 and 2023. Incidence odds ratios (IOR) were calculated by age group. 7,918,666 individuals had T2D. The IOR (95 % CI), comparing individuals aged ≥ 85 years to < 35 years decreased for all complications from 2012 to 2023: IHD [IOR 6.82, (6.40, 7.26) to IOR 2.27 (2.17, 2.38)], heart failure [IOR 5.38, (5.03, 5.75) to IOR 1.80 (1.72, 1.89)], cerebral infarction [IOR 3.06, (2.76, 3.40) to IOR 1.45 (1.34, 1.57)], neuropathy [IOR 0.84, (0.74, 0.95) to IOR 0.47 (0.44, 0.49)], nephropathy [IOR 1.14, (1.03, 1.27) to IOR 0.90 (0.87, 0.94)] and retinopathy [IOR 0.56, (0.50, 0.63) to IOR 0.27 (0.25, 0.29)]. Rising rates of T2D associated complications in younger adults signal an emerging epidemic of early-onset comorbidity with substantial lifetime burden. These findings emphasise the urgent need for earlier detection, aggressive risk factor management, and targeted prevention strategies in younger populations.