From 1999 to 2023, obesity, chronic lung disease, and total number of comorbidities increased among U.S. adults with newly ascertained diabetes, and multimorbidity patterns increasingly encompassed both concordant and discordant conditions, potentially complicating management and worsening outcomes.
Key Findings
Results
Obesity prevalence significantly increased among U.S. adults with newly ascertained diabetes between 1999 and 2023.
Obesity rose from 58.3% in 1999-2006 to 71.0% in 2015-2023 (p=0.0003).
This represents an approximately 12.7 percentage point increase over the study period.
Data were drawn from the National Health and Nutrition Examination Survey (NHANES) for adults ≥20 years with newly ascertained diabetes (n=4,243).
Newly ascertained diabetes was defined as diagnosed at the survey or ≤2 years prior.
Results
Chronic lung disease prevalence significantly increased among adults with newly ascertained diabetes over the study period.
Chronic lung disease rose from 15.4% in 1999-2006 to 22.8% in 2015-2023 (p=0.007).
This represents an approximately 7.4 percentage point increase.
Trends were assessed using logistic and linear regression across three time periods.
Age-adjusted prevalence estimates were used for all comorbidity analyses.
Results
Chronic kidney disease and cardiovascular disease prevalence remained stable among adults with newly ascertained diabetes across the study period.
Chronic kidney disease remained approximately stable at ~30% across the study periods.
Cardiovascular disease ranged from 11.8% to 14.1% and was considered stable.
These conditions are classified as concordant vascular diseases, meaning they share pathophysiological mechanisms with diabetes.
Stability was assessed using logistic regression across the three time periods.
Results
Arthritis, sleep disorders, and dental caries were common but stable comorbidities among adults with newly ascertained diabetes.
Arthritis prevalence remained approximately stable at ~40% across study periods.
Sleep disorders ranged from 29.2% to 38.5% but were considered stable in trend analysis.
Dental caries remained approximately stable at ~30%.
These conditions represent discordant comorbidities, which do not share the same metabolic risk factors as diabetes.
Results
The mean number of comorbidities among adults with newly ascertained diabetes increased significantly from 1999 to 2023.
Mean comorbidity count increased from 4.25 in 1999-2006 to 4.51 in 2015-2023 (p=0.038).
The analysis included 13 comorbidities spanning concordant metabolic risk factors, concordant vascular diseases, and discordant conditions.
Linear regression was used to assess trends in mean comorbidity count.
The sample included 4,243 adults with newly ascertained diabetes from NHANES 1999 through August 2023.
Results
Multimorbidity patterns among adults with newly ascertained diabetes increasingly encompassed both concordant and discordant conditions over the study period.
Greater overlap of concordant and discordant conditions was statistically significant (p=0.008).
Pattern distributions were assessed using chi-square tests.
The study distinguished between concordant metabolic risk factors, concordant vascular diseases, and discordant conditions as separate categories of comorbidity.
Increasing overlap of condition types was described as potentially complicating management and worsening outcomes.
What This Means
This research examined how the health conditions present at the time of a new diabetes diagnosis have changed over more than two decades in the United States. Using data from a large, nationally representative health survey (NHANES) collected between 1999 and 2023, researchers tracked 13 different health conditions in over 4,000 adults who had been recently diagnosed with diabetes. They categorized these conditions as either 'concordant' (conditions that share the same underlying causes as diabetes, like obesity and heart disease) or 'discordant' (conditions that are common in people with diabetes but have different root causes, like arthritis and sleep disorders).
The study found that obesity among newly diagnosed diabetic adults increased substantially, from about 58% to 71%, and chronic lung disease also rose significantly, from about 15% to 23%. On average, people newly diagnosed with diabetes had more total health conditions in 2015-2023 than in 1999-2006 (4.51 versus 4.25 conditions on average). Notably, individuals increasingly had a mixture of both concordant and discordant conditions at the time of diagnosis, rather than just one type. Conditions like chronic kidney disease, cardiovascular disease, arthritis, sleep disorders, and dental caries remained common but did not show significant changes over time.
This research suggests that people being diagnosed with diabetes today are entering treatment with a more complex mix of health problems than in previous decades. Having multiple, diverse health conditions at once can make diabetes management more challenging because treatment guidelines and clinical decisions are often designed around individual diseases rather than combinations of them. These findings highlight the growing need for integrated, whole-person approaches to care for people newly diagnosed with diabetes.
Onufrak S, Zaganjor I, Choi D, Han S, Holliday C, Pavkov M. (2026). Trends in comorbidities and multimorbidity among adults with recently diagnosed diabetes: United States, 1999-2023.. Diabetes research and clinical practice. https://doi.org/10.1016/j.diabres.2026.113530