A research team led by Professor Lim Soo of the Department of Endocrinology and Metabolism at Seoul National University Bundang Hospital has published a review article in Nature Reviews Disease Primers presenting the latest scientific understanding of type 2 diabetes as a complex systemic disease involving multiple organs and biological pathways.
Review articles in the journal are typically commissioned from internationally recognized experts and provide broad overviews of major developments in a field. Professor Lim served as a co-first author of the paper.
Professor Lim Soo (Courtesy of SNUBH)
Type 2 diabetes is a progressive disease characterized by chronically elevated blood glucose levels. As obesity rates continue to rise worldwide, the prevalence of diabetes has increased sharply. According to the International Diabetes Federation, the global number of people living with diabetes reached approximately 830 million in 2022 -- more than triple the figure recorded in 1980 -- with more than 90 percent of cases classified as type 2 diabetes.
The research team highlighted the rapid increase in “early-onset diabetes,” diagnosed before the age of 40.
Early-onset diabetes is associated with faster progression of complications and greater mental health burdens. The study noted that for every 10 years earlier the disease is diagnosed, life expectancy may be reduced by three to four years. Because the condition often develops during the most active stages of life -- including education, employment, and child-rearing years -- it can significantly diminish quality of life and create substantial social and economic burdens.
Researchers also emphasized that diabetes is increasingly being linked not only to traditional complications, such as cardiovascular and kidney diseases, but also to mental health conditions and elevated cancer risk. As a result, a broader approach to diabetes management beyond glucose-centered care is gaining traction.
To address this shift, the team proposed a new model explaining the development of type 2 diabetes. Rather than viewing it solely as a pancreatic disorder, the researchers systematically described how 13 interconnected mechanisms -- referred to as the “tumultuous thirteen” -- involving the liver, muscles, brain, gut, and other organs collectively contribute to the disease. Based on this framework, the team stressed that treatment paradigms are moving beyond simple blood sugar reduction toward comprehensive whole-body management.
One prominent example of this transition is the growing use of GLP-1-based therapies. These medications have demonstrated not only improved glycemic control and weight reduction, but also reduced cardiovascular risk, reshaping treatment strategies for type 2 diabetes. In patients with prediabetes accompanied by obesity, some studies have reported up to a 93 percent reduction in the risk of progression to type 2 diabetes.
The study also reemphasized the importance of lifestyle modification. Regular exercise sustained for more than eight weeks was shown to significantly lower blood glucose levels, while increasing daily walking by just 500 steps was associated with reduced cardiovascular disease incidence and mortality risk.
In addition, the research team highlighted the psychological challenges people with diabetes face in daily life. About 80 percent of diabetes patients reported experiencing stigma, negative perceptions, or discrimination because of their condition. Such stigma directly undermines self-management motivation and quality of life. The study further found that roughly one-quarter of patients experience depression, while about one-third suffer from psychological distress.
Professor Lim said, “This study reconfirms that type 2 diabetes is not simply a matter of blood sugar control, but a complex chronic disease involving the entire body.”
He added, “Beyond conventional approaches focused solely on glucose management, integrated treatment strategies addressing body weight, cardiovascular risk, and mental health are now essential.”
Professor Lim further emphasized the urgency of establishing proactive screening programs and tailored management systems for younger populations, noting the rapid increase in diabetes prevalence among young people in Korea.
Kim Ji-hye
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