Global Burden and Evolving Therapeutic Strategies in Diabetes Mellitus: A Comprehensive Review

ABSTRACT:

Diabetes mellitus (DM) has emerged as one of the most challenging chronic diseases of the 21st century, affecting hundreds of millions of people globally. Its prevalence continues to rise due to lifestyle transitions, urbanization, and population ageing. Diabetes contributes significantly to morbidity, mortality, and healthcare expenditure worldwide. Type 2 diabetes (T2D) represents about 90–95% of all cases, driven by insulin resistance and β-cell dysfunction. In recent years, major therapeutic advances have reshaped management, particularly with sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and the dual glucose-dependent insulinotropic peptide (GIP)/GLP-1 receptor agonist tirzepatide. These agents not only control glycaemia but also offer cardiovascular and renal protection. Despite these advances, global disparities in diagnosis, access to care, and affordability persist, especially in low- and middle-income countries (LMICs). This review summarizes the global epidemiology, pathophysiology, and evolving therapeutic strategies in diabetes, highlighting contemporary clinical trials, outcome data, and future priorities for reducing its global burden. 

Keywords: Diabetes mellitus, SGLT2 inhibitors, GLP-1 receptor agonists, tirzepatide, global burden, cardiovascular outcomes.