Daily Endocrinology Research Analysis

AIMS/HYPOTHESIS: Despite evidence documenting high prevalence of type 2 diabetes among several Indigenous populations, a comprehensive systematic review of type 2 diabetes among global Indigenous Peoples has not been recently conducted. Our aim was to report region-, time-, age- and sex-specific type 2 diabetes prevalence among Indigenous adult populations globally. METHODS: MEDLINE, Embase and CINAHL were searched for English-language studies published between 1 January 1980 and 3 March 2023. Studies reporting type 2 diabetes prevalence and/or cases of diabetes among global Indigenous adult populations aged 18 years and older were included. Type 2 diabetes prevalence data were extracted for the overall Indigenous population, sex, age group and year. Summaries of extracted data were tabulated, and are presented using comprehensive tables and figures. A modified Newcastle-Ottawa quality assessment scale reflective of Indigenous-specific criteria was applied to assess paper quality. RESULTS: The search identified 2332 studies, of which 202 met the inclusion criteria. The included studies represented at least 187 Indigenous populations from 37 countries, although the exact number of populations is approximate, as some studies did not name specific Nations/Tribes/Groups for populations from different geographic regions. Diabetes prevalence ranged from 0 to 40%, with a mean of 73% of Indigenous populations reporting type 2 diabetes prevalence above the estimated global prevalences for every decade between 1980 and 2020. Prevalence increased over time and with age for many populations, with the highest reported prevalence (50.5%) in the 45-54 year age group. Type 2 diabetes prevalence was notably high among Indigenous women, with 73% of studies reporting higher prevalence for Indigenous women than for Indigenous men. Potential limitations include publication bias, which may have led to fewer studies being included in this review. CONCLUSIONS/INTERPRETATION: Type 2 diabetes prevalence among Indigenous adult populations was markedly higher than the global averages in every decade from 1980 to 2020, with a mean of 73% of populations reporting higher prevalence. These findings underscore the persistent and disproportionate burden of diabetes experienced by many Indigenous communities over several decades. Future work should aim to generate representative data on type 2 diabetes prevalence across global Indigenous populations, investigate factors that contribute to alarmingly high and notably low diabetes prevalence, and support Indigenous-led, culturally safe, Indigenous population-specific health practices to prevent and manage type 2 diabetes and achieve equitable outcomes. FUNDING: There was no funding source for this study. TRIAL REGISTRATION: PROSPERO registration no. CRD42021258623.

Insulin resistance increases after the first trimester of pregnancy, leading to glycaemic challenges for women with pregestational type 1 diabetes or type 2 diabetes. Additionally, insulin resistance can promote hyperglycaemia in pregnant women without type 1 diabetes or type 2 diabetes, who develop gestational diabetes. Although most (>95%) women with diabetes deliver healthy babies, maternal dysglycaemia can have consequences for the mother and child, including prenatal, perinatal, immediate, and long-term postnatal complications. Diabetes technologies, such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems can aid in optimising glycaemia outside of pregnancy. These novel technologies have not been extensively tested in large randomised controlled trials before and during pregnancy. However, compelling data report the benefits of CGM in type 1 diabetes, and increasing data report on AID systems in pregnancies complicated by type 1 diabetes. Appropriate CGM glucose thresholds for the diagnosis of gestational diabetes and the recommended time in range treatment targets for the routine management of gestational diabetes and type 2 diabetes still need to be determined. The recommendations in this Consensus Statement emphasise the value of CGM during preconception and pregnancy for women with pregestational type 1 diabetes in reducing pregnancy complications. Recommendations also include the use of AID systems in women with pregestational type 1 diabetes to improve glycaemic management during preconception, during pregnancy and delivery, and in the postpartum period. This Consensus Statement has been endorsed by 24 societies and groups.

OBJECTIVE: To evaluate the independent and joint associations of social determinants of health (SDOH) and healthy lifestyle factors with life expectancy among adults with cardiovascular-kidney-metabolic (CKM) syndrome. RESEARCH DESIGN AND METHODS: We analyzed two prospective population-based cohorts: the UK Biobank (2006-2010) and the US National Health and Nutrition Examination Survey (NHANES, 1999-2018). Adults with CKM at baseline and complete data on SDOH and lifestyle indicators were included. Cox proportional hazards models were used to estimate mortality risk by CKM stage, SDOH, and lifestyle adherence. Life expectancy at age 50 was calculated using life table methods, stratified by CKM stage and levels of SDOH and lifestyle. RESULTS: A total of 213,738 UK Biobank participants (6.69 % deaths) and 10,345 NHANES participants (9.48 % deaths) were included. Advanced CKM stages were associated with significantly higher mortality risk and shorter life expectancy in both cohorts. Individuals with higher SDOH weighted scores or lower healthy lifestyle scores had elevated mortality risks. The joint effects of poor CKM status, adverse SDOH, and unhealthy lifestyle were additive. In NHANES, life expectancy at age 50 ranged from 33.9 years (CKM stage 0 with healthy lifestyle) to 13.2 years (CKM stage 4 with unhealthy lifestyle). In the UK Biobank, the corresponding figures were 34.2 and 21.7 years. CONCLUSIONS: In two large cohorts, poorer CKM health, greater social disadvantage, and unhealthy lifestyles were each independently and jointly associated with lower life expectancy. These findings support the need for integrated strategies targeting both social and behavioral factors to improve outcomes in CKM populations.