Quantifying the individual disease duration-adjusted burden of complications in persons with type 2 diabetes

Background and aims: The burden of type 2 diabetes (T2D)-related complications (DRCs) shows marked interindividual variability. We aimed to develop a method to estimate the burden and rate of accumulation of complications in relation to disease duration using standard clinical assessments. Methods and results: We analyzed the clinical records of 1302 subjects from four diabetes clinics who underwent comprehensive screening for macrovascular and microvascular complications. Overt and subclinical complications were defined using standardized criteria and assigned 3 and 1 point, respectively. Microvascular and macrovascular complications tended to cluster (chi2 p < 0.0001). The global DRC score increased with diabetes duration (r = 0.34, p = 1∗10-21), and regression analysis indicated a theoretical score of zero approximately 13 years before diagnosis. Assuming −13 years as intercept, we calculated the individual rate of complication accrual and classified patients into tertiles corresponding to low (LB), moderate (MB), and high burden (HB) groups. The mean accrual rates were 0.14 [95%CI:0.13-0.16], 0.88 [95%CI:0.85-0.91], and 2.31 [95%CI: 2.24-2.39] points per 10 years, respectively. According to these models, the first subclinical complication was expected to occur approximately 65 years after diagnosis in the lowest tertile and 2 and 9 years before diagnosis in the moderate and highest tertiles, respectively. The three groups showed only marginal differences in age, diabetes duration, and HbA1c. Conclusion: Using real-world data, we identified thresholds that allow classification of patients with T2D according to the rate of accrual of complications relative to disease duration. This framework may facilitate research aimed at identifying biological determinants of variability in complication development. Trial registration: NCT07250607, registered on 23/11/2025.