Global prevalence of multimorbidity among people living with type 2 diabetes: a systematic review and meta-analysis

Abstract

Multimorbidity is increasing over time and causes a major global health challenge among individuals with type 2 diabetes (T2D). The growing prevalence of multimorbidity coupled with its complex management leads to a significant concern for the healthcare system. Evidence of existing studies on multimorbidity showed inconsistencies across different regions in the world. This study aimed to summarize and estimate the pooled global prevalence of multimorbidity and its associated factors among patients with T2D. A systematic review and meta-analysis were conducted, including studies up to January 2025. PubMed, HINARI, CINAHL/EBSCO, the Cochrane Library, ProQuest, Google Scholar, and Google were used to search studies. The quality of the selected articles was evaluated using the Joanna Briggs Institute (JBI) checklist. The pooled prevalence was estimated using a random effect model with a 95% confidence interval (CI), while a fixed effect model was used to assess the pooled adjusted odds ratios (AORs) for the exposure variables. Heterogeneity was assessed using I² statistics and Cochran’s Q test (p-value). Subgroup analysis and meta-regression were used to identify the sources of variation. Publication bias was assessed using a funnel plot and Egger’s test (p-value < 0.05). In this review, a total of 32 studies and 2,934,500 participants were included. The pooled global prevalence of multimorbidity among T2D was 83.17%, concordant conditions (related to T2D) was 50.21%, discordant conditions (unrelated to T2D) was 47.24%, and combined conditions (having both chronic conditions) was 58.90%. Age 40–59 years (AOR = 2.36, 95% CI: 1.17–3.55), being retired (AOR = 1.31, 95% CI: 0.96–1.66), non-formal education (AOR = 2.93, 95% CI: 1.44–4.42), being widowed (AOR = 2.00, 95% CI: 1.04–2.96), and being a current smoker (AOR = 2.33, 95% CI: 1.16–3.50) were the predictors of multimorbidity. Being an urban resident (AOR: 1.69, 95% CI: 0.95–2.44) was associated with concordant chronic conditions. Multimorbidity is highly prevalent among type 2 diabetes, emphasizing a major public health challenge. It is important to develop a well-designed and comprehensive strategy to enhance the prevention and management of multimorbidity. Particular emphasis should be given to older adults, people who have a low level of education, retired individuals, smokers, widowed individuals, and people living in urban residences. PROSPERO-CRD42025639310. Registered on January 16/2025.