The risk of developing chronic kidney disease (CKD) or heart failure (HF), or dying, following a type 2 diabetes (T2D) diagnosis increases substantially over time, according to new research being presented at the Annual Meeting of The European Association for the Study of Diabetes (EASD) in Milan, Italy (Sept 28 – Oct 2).
The study, which analysed data from more than 1.6 million patients across the USA, found that the combined risk of developing CKD or HF, or dying, was 33% on average within the first five years of a T2D diagnosis, rising to 55% over 10 years.
The researchers say their findings underscore the critical importance of early, proactive and more holistic approaches to the management of type 2 diabetes to help reduce the risk of serious complications.
T2D is projected to become the biggest epidemic disease in the world, affecting an estimated 1.3 billion people by 2050 [1]. It frequently occurs alongside other conditions, including obesity, high blood pressure, HF, CKD and depression, contributing substantially to the global burden of multimorbidity. This causes considerable suffering for people living with T2D and economic stress for many countries, especially low- and middle-income countries.
However, how quickly and in what order people newly diagnosed with T2D develop serious complications such as CKD and HF is not fully understood.
To address these knowledge gaps, researchers analysed real-world data from the CALOR observational study programme [2] to estimate the risk of developing CKD or HF following a new T2D diagnosis, the risk of developing the other complication within five years of the first, and the combined risk of developing CKD or HF, or dying, within five and 10 years of diagnosis.
They included 1,617,508 patients newly diagnosed with T2D between 1 st January 2010 and 31 st March 2024 from across the USA. The average age of participants at enrolment was 59 years, and 51% were female. Among the 13% of patients who had a body mass index (BMI) recorded, the average (median) was 30.9 kg/m².
Almost three-quarters (72%) of participants were also living with dyslipidaemia (high levels of cholesterol and other fats in the blood), and over two thirds (68%) had high blood pressure.
Within five years of a first T2D diagnosis, the risk of developing CKD first was more than twice that of developing HF first (19.0% vs 8.3%; see figure in notes to editors).
However, among people who developed HF first, there was a 42% risk of developing CKD within the following five years. Conversely, among those who developed CKD first, there was a 23% risk of developing HF within the following five years.
"Our findings clearly show how the serious complications associated with type 2 diabetes rise sharply over time as the often common combination in patients of obesity, abnormal blood fats, high blood pressure and higher blood sugar damages blood vessels, and vital organs," said Professor Naveed Sattar of the University of Glasgow, Scotland, UK who co-led the study. "Our results emphasise the critical importance of detecting and treating type 2 diabetes thoroughly at the earliest opportunity to help reduce the risk of serious complications.”
The study has several limitations, including that it was observational and can’t prove causation and it can’t rule out the probability of selection bias, which is a common limitation of real-world evidence. For example, the influence of race and ethnicity on the risk of developing CKD or HF may have influenced the results.
26-Sep-2026
Naveed Sattar declares employment/consultancy with AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, Gan & Lee, GlaxoSmithKline, Hanmi Pharmaceuticals, Kailera, Mass Medicines, Menarini-Ricerche, Metsera, Novo Nordisk, Pfizer, Regeneron, Roche, UCB Pharma and Verdiva Bio. Grants; Institutional research funding from AstraZeneca, Boehringer Ingelheim, Novartis and Roche.