Daily Endocrinology Research Analysis
Analyzed 19 papers and selected 3 impactful papers.
Summary
Three high-impact endocrinology papers stand out today: a PROSPERO-registered systematic review showing persistently elevated type 2 diabetes prevalence among Indigenous Peoples worldwide; an international consensus endorsing CGM and recommending AID use for pregnant women with type 1 diabetes; and dual-cohort evidence that adverse SDOH and unhealthy lifestyle additively shorten life expectancy across CKM stages. These works collectively sharpen equity-focused diabetes epidemiology, guide pregnancy care, and quantify the social-behavioral impact on cardiometabolic outcomes.
Research Themes
- Diabetes equity and epidemiology
- Diabetes technology in pregnancy
- Social determinants and cardiometabolic risk
Selected Articles
1. Prevalence of type 2 diabetes among global Indigenous adult populations: a systematic review.
This PROSPERO-registered systematic review synthesizes 202 studies across at least 187 Indigenous populations in 37 countries. Type 2 diabetes prevalence frequently exceeded global averages in every decade from 1980–2020, increased with age, peaked in midlife (45–54 years), and was often higher in women. The authors call for representative data and Indigenous-led, culturally safe strategies.
Impact: This is the most comprehensive, protocol-registered synthesis of type 2 diabetes prevalence among Indigenous Peoples, quantifying decades-long inequities and identifying sex- and age-specific burdens.
Clinical Implications: Clinicians and systems should prioritize proactive screening and culturally safe, community-led interventions for Indigenous populations, with attention to women and individuals in midlife.
Key Findings
- Included 202 studies covering at least 187 Indigenous populations from 37 countries.
- Across 1980–2020, a mean of 73% of Indigenous populations reported type 2 diabetes prevalence above global estimates.
- Prevalence increased over time and with age; the highest reported prevalence was 50.5% in ages 45–54.
- Indigenous women frequently had higher prevalence than men in 73% of studies.
- Limitations included possible publication bias and incomplete naming of specific Nations/Tribes.
Methodological Strengths
- Protocol registered in PROSPERO (CRD42021258623).
- Quality assessment using a modified Newcastle–Ottawa Scale incorporating Indigenous-specific criteria.
Limitations
- Potential publication bias may have reduced the number of included studies.
- Some studies did not identify specific Nations/Tribes, limiting granularity.
Future Directions: Generate representative, nation-specific prevalence data; investigate drivers of both high and low prevalence; and scale Indigenous-led, culturally safe prevention and management programs.
2. Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statement.
This international consensus emphasizes CGM use before conception and throughout pregnancy in women with type 1 diabetes and supports AID systems to improve glycaemic management during pregnancy and postpartum. It highlights evidence gaps for CGM diagnostic thresholds and time-in-range targets in gestational and type 2 diabetes, calling for trials.
Impact: Endorsed by 24 organizations, these recommendations may rapidly standardize the use of CGM and AID in pregnancy, addressing a high-risk period with limited RCT data.
Clinical Implications: Adopt CGM for women with type 1 diabetes preconception through postpartum; consider AID systems with multidisciplinary oversight. Exercise caution for gestational and type 2 diabetes pending validated CGM thresholds and treatment targets.
Key Findings
- Insulin resistance increases after the first trimester, complicating glycaemic control in pregnancy.
- Compelling evidence supports CGM in type 1 diabetes; growing evidence supports AID during type 1 diabetes pregnancies.
- Appropriate CGM glucose thresholds for GDM diagnosis and time-in-range targets for GDM and type 2 diabetes remain to be determined.
- Recommendations are endorsed by 24 societies and address preconception, pregnancy, delivery, and postpartum care.
Methodological Strengths
- International, multi-society consensus integrating available clinical and technological evidence.
- Actionable, lifecycle-oriented recommendations spanning preconception to postpartum.
Limitations
- Limited large RCT evidence before and during pregnancy for CGM/AID.
- Unresolved diagnostic thresholds and treatment targets for GDM and type 2 diabetes.
Future Directions: Conduct RCTs and pragmatic trials of CGM/AID across pregnancy stages; define CGM diagnostic thresholds and TIR targets for GDM and type 2 diabetes; evaluate maternal–fetal safety and health-system implementation.
3. SDOH, healthy lifestyle, and life expectancy in adults with CKM syndrome: two cohort studies.
Across UK Biobank and NHANES, worse CKM stages, adverse SDOH, and unhealthy lifestyle were independently and additively associated with higher mortality and shorter life expectancy. Life expectancy at age 50 varied widely by CKM status and behaviors, underscoring the need for integrated social–behavioral interventions.
Impact: This study quantifies how social disadvantage and lifestyle jointly shape life expectancy across CKM stages in two large cohorts, offering directly actionable targets for risk stratification and intervention.
Clinical Implications: In CKM populations, embed SDOH assessment and lifestyle counseling into routine care to improve survival. Use CKM stage with SDOH and lifestyle scores to prioritize intensive management.
Key Findings
- Included 213,738 UK Biobank and 10,345 NHANES participants with CKM at baseline.
- Advanced CKM stages correlated with higher mortality and shorter life expectancy in both cohorts.
- Higher SDOH weighted scores and lower healthy lifestyle scores independently increased mortality risk.
- The joint effects of CKM status, SDOH, and lifestyle were additive, markedly widening life expectancy gaps.
- At age 50, life expectancy ranged from 33.9 to 13.2 years in NHANES and from 34.2 to 21.7 years in UK Biobank across best to worst profiles.
Methodological Strengths
- Two large, population-based cohorts with consistent findings across countries.
- Use of Cox models and life table methods to quantify mortality risk and life expectancy.
Limitations
- Observational design limits causal inference.
- Potential residual confounding and incomplete specification of some thresholds/targets.
Future Directions: Test integrated interventions addressing SDOH and lifestyle across CKM stages; refine CKM staging and risk tools by incorporating social and behavioral metrics; evaluate implementation in diverse health systems.