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Saharan Africa is experiencing a rapid increase in the burden of diabetes, accompanied by increasing rates of microvascular, macrovascular, and pregnancy-related complications. This Series paper synthesises current evidence on diabetes-related complications in sub-Saharan Africa and examines shared cardiometabolic risks, mental health comorbidities, and interactions with communicable diseases through a multiple long-term conditions lens. Widespread late diagnosis and inadequate control of key cardiometabolic risk factors (eg, hypertension, dyslipidaemia, obesity, and hyperglycaemia) drive high complication rates-whereas mental health disorders and infectious disease comorbidities further exacerbate susceptibility. Although risk factor reduction is central to preventing diabetes complications in sub-Saharan Africa, progress is impeded by multilevel barriers spanning individual, interpersonal, health system, societal, and policy domains. To address this growing complexity, we identify priorities for research and implementation, including the development of context-specific guidelines, scalable integrated care models, strengthened surveillance systems, and long-term cohorts co-designed with communities, health-care providers, and policy makers.