This study examines the link between early-onset diabetes and health factors in South Korean young adults (20-39) using data from the Korea National Health and Nutrition Examination Survey (2010-2020).

A matched case-control study was conducted in 2022 with 103 patients with diabetes and 103 controls, matched by age, gender, and BMI. All data, including socioeconomic status (income, education, occupation), health behaviors (smoking, alcohol consumption, physical activity), and medical histories, were extracted from the KNHANES database. We analyzed socioeconomic status, health behaviors, and medical histories using descriptive statistics, chi-square tests, and binary logistic regression.

The study revealed that educational attainment and economic status are substantial predictors of diabetes, with those holding only a high school diploma showing a nearly threefold increased risk compared to college graduates (OR = 2.986; 95% CI = 1.334-6.687). Additionally, participants with a higher number of chronic diseases (OR = 3.534; 95% CI: 1.547-8.073) and those who felt unwell in the past two weeks (OR = 4.010; 95% CI: 1.388-11.585) also demonstrated significantly increased odds of diabetes. And having a parent with diabetes was an exceptionally strong predictor, with these participants having a significantly increased risk of diabetes (OR = 47.022; 95% CI = 4.206-525.704).

The study emphasizes that improving educational and economic conditions, coupled with targeted screening programs for individuals with a family history of diabetes, may be effective in curbing the tide of early-onset diabetes in South Korea. These strategies may have profound implications for public health policies aimed at mitigating the risk in this increasingly vulnerable group.

As an emerging health technology, pharmacogenetic (PGx) testing has the capacity to improve medication therapy. However, implementation in medically underserved populations (MUPs) remains limited, which has the potential to increase healthcare disparities. While there is no single accepted definition for MUPs, demographic, socioeconomic, cultural, and geographic factors can lead to reduced access to healthcare, which contributes to disparate health outcomes in these populations. In the case of PGx testing, as MUPs have an increased risk of adverse drug events, have lower numbers of healthcare encounters, and are prescribed more medications which can be guided by PGx testing, additional benefits from PGx testing may occur in MUPs. Study of the acceptability and perceptions of PGx testing in MUPs, as reported in literature, provides support for the development of successful PGx testing implementations. Additionally, a few limited pilot PGx testing implementations in MUPs have assessed feasibility. However, further studies establishing the feasibility and effectiveness of PGx testing implementations in MUPs will enable more widespread PGx testing in those who are medically underserved. Thus, this narrative review explores the impact of medical underservice on health, PGx testing's potential impact on MUPs, and the research and early clinical implementations of PGx in MUPs.

Observational studies have shown that more educated people are at lower risk of developing type 2 diabetes (T2D). However, robust study designs are needed to investigate the likelihood that such a relationship is causal. This study used genetic instruments for education to estimate the effect of education on T2D using the Mendelian randomisation (MR) approach.

Analyses have been conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study (more than 20 000 individuals), a case-cohort study of T2D nested in the EPIC cohort. Education was measured as Years of Education and Relative Index of Inequality. Prentice-weighted Cox models were performed to estimate the association between education and T2D. One-sample MR analyses investigated whether genetic predisposition towards longer education was associated with risk of T2D and investigated potential mediators of the association.

MR estimates indicated a risk reduction of about 15% for each year of longer education on the risk of developing T2D, confirming the protective role estimated by observational models (HR 0.96, 95% CI 0.95 to 0.96). MR analyses on putative mediators showed a significant role of education on body mass index, alcohol consumption, adherence to the Mediterranean diet and smoking habits.

The results supported the hypothesis that higher education is a protective factor for the risk of developing T2D. Based on its position in the causal chain, education may be antecedent of other known risk factors for T2D including unhealthy behaviours. These findings reinforce evidence obtained through observational study designs and bridge the gap between correlation and causation.

To explore the mediated role of patient compliance between illness perception and quality of life in geriatric Chinese patients with type 2 diabetes mellitus.

It was a cross-sectional study and included 302 geriatric patients with type 2 diabetes mellitus. The mediated effect model was employed to investigate the link between illness perception, patient compliance, and quality of life.

A strong positive link between illness perception and quality of life (r = 0.784, P < 0.001), but a significantly negative correlation with patient compliance (r = -0.618, P < 0.001). There was a substantial negative association found between patient compliance and quality of life (r = -0.678, P < 0.001). Patient compliance mediated the influence of illness perception on quality of life, accounting for 22.62% of the overall effect.

Improving patient compliance in geriatric patients with type 2 diabetes mellitus should become a priority target.

This study examines socio-economic inequalities in the prevalence and treatment of hypertension and diabetes among adults in India, utilising data from the National Family Health Survey (NFHS) collected before and during the COVID-19 pandemic. Disparities associated with individual demographic and socio-economic characteristics are measured, with the level of inequality quantified using the dissimilarity index and contributing factors analysed through decomposition analysis. The results reveal significant socio-economic gradients, with wealthier individuals more likely to have elevated blood pressure and blood glucose levels and to treat them. Socio-economic gradients in treatment are even steeper among middle-aged groups during the pandemic. These wealth- and education-related disparities become more pronounced with age. This study highlights the need for targeted interventions and policies to address socio-economic disparities in access to essential care for socio-economically disadvantaged populations.

Health education is integral to cardiometabolic disease (CMD) management. Certain populations, such as people with lower educational attainment have higher risk of CMD and worse outcomes. They are also known to have differing preferences for health education formats and delivery compared with the general population. This study assessed the efficacy of CMD educational interventions in populations with lower educational attainment.

Four databases (Medline, Proquest, CINAHL, and Google Scholar) were systematically searched to identify studies using an educational intervention, targeting CMD-related outcomes, in a population with low educational attainment, in a community or primary care setting. A random-effects meta-analysis was conducted to calculate pooled mean differences.

Educational interventions were associated with statistically significant improvements at approximately 3 months, compared with baseline, in terms of BMI (mean difference [95 % confidence interval] = -0.27 [-0.42, -0.12] kg/m2; p < 0.001), weight (-0.20 [-0.35, -0.06] kg; p = 0.007), % fat in diet (-2.45 [-3.08, -1.81]; p < 0.001), systolic blood pressure (-0.51 [-0.98, -0.05] mmHg; p = 0.031), total cholesterol (-0.54 [-0.70, -0.38] mg/dL; p < 0.001), HbA1c (-0.46 [-0.74, -0.17] %; p = 0.002), physical activity (1.04 [0.43, 1.66] hours/week; p < 0.001), and CES depression score (-0.72 [-1.16, -0.27]; 0.002). However, where 12 or 24 month follow-up data were available, there were no statistically significant differences compared with baseline.

CMD education interventions can improve multiple outcomes in the short term in people with lower educational attainment. Further work is needed around how such benefits may be maintained.

Diabetes is a leading cause of death in the U.S. Previous studies have found substantial racial, ethnic, and geographical disparities in diabetes mortality; however, research considering racial, ethnic, and geographical disparities simultaneously has been limited. To fill this gap, we estimated trends in diabetes mortality rates from 2000 to 2019 at the county level for five racial and ethnic populations.

We applied small-area estimation methods to death registration data from the U.S. National Vital Statistics System and population data from the U.S. National Center for Health Statistics and corrected for misclassification of race and ethnicity on death certificates.

Age-standardized diabetes mortality rates decreased in the U.S. from 28.1 deaths per 100,000 (95% uncertainty interval 27.9-28.2) in 2000 to 19.1 deaths per 100,000 (19.0-19.2) in 2019. In 2019, national-level rates were highest for the American Indian or Alaska Native (AIAN) population (35.6 [32.1-39.4]), followed by the Black (31.9 [31.5-32.3]), Latino (19.7 [19.3-20.2]), White (17.6 [17.5-17.8]), and Asian (12.6 [12.1-13.1]) populations. There was substantial heterogeneity in diabetes mortality rates across counties within each racial and ethnic population, with the AIAN population experiencing the greatest heterogeneity in 2019 (interquartile range 18.7-50.3 [median 31.9]). For each racial and ethnic population, mortality rates declined in most counties from 2000 to 2019.

Since 2000, progress has been made in reducing diabetes mortality rates. Nonetheless, diabetes mortality remains too high for many Americans. Interventions focusing on communities at highest risk are vital to resolving persistent health inequities.

This study aims to analyze prescription patterns of new diabetes medication and assess socioeconomic disparities in their initiation among individuals with T2DM with very high cardiovascular risk.

Individuals diagnosed with T2DM and very high cardiovascular risk were identified (N = 10,768) based on general practitioner's electronic health record data. SGLT-2is and GLP-1RAs prescription patterns were examined. Furthermore, the association between SES and the prescription of SGLT-2is and GLP-1RAs in 2022 was investigated.

Despite the increase in prescription rates of SGLT-2is and GLP-1RAs between 2019 and 2022, approximately 85 % and 93 % of eligible individuals did not receive SGLT-2is and GLP-1RAs in 2022, respectively. We found a positive association between SGLT-2is prescription and SES in only the 4th quintile compared to 1st quintile (referent) in the fully adjusted model (OR 1.29 95 % CI:1.08-1.54).

The prescription rates among eligible individuals highlight significant room for improvement in aligning prescribing practices with guidelines. We found no profound socioeconomic gradient in initiation of SGLT-2is and GLP-1RAs. The latter may be due to guidelines' clear indication of the eligible population and GP education. Future development and potential disparities in initiation and maintenance should be monitored to ensure equitable prescribing.

To explore the holistic impact of socioeconomic and mental health inequalities on the global burden of type 2 diabetes.

This cross-sectional study used data on the incidence, disability-adjusted life years (DALYs), and mortality of type 2 diabetes as well as DALYs attributable to risk factors during 1990-2021 from the Global Burden of Disease Study 2021. Average annual percent change (AAPC) was applied to assess the temporal trends from 1990 to 2021. Countries were categorised according to levels of sociodemographic index (SDI) and prevalence of depressive disorders or anxiety disorders.

In 2021, the highest age-standardised incidence rate (per 100 000 population) for type 2 diabetes was in countries with a higher prevalence of depressive or anxiety disorders (ranging from 466.35 to 517.08), wherein those with higher SDI experienced the fastest increase from 1990 to 2021 (AAPC ranging from 2.51% to 2.61%). The highest age-standardised rates of DALY and mortality (per 100 000 population) for type 2 diabetes in 2021 were in countries with lower SDI, of which countries with a higher prevalence of depressive or anxiety disorders exhibited the greatest burden (ranging from 1714.38 to 2012.12 for DALY; from 48.66 to 51.91 for mortality). The attributable risk factors for DALYs of type 2 diabetes varied across countries with different SDI levels and prevalence of mental disorders.

The results suggest that the imbalance of faster socioeconomic development but worse mental health underpins diabetes incidence, while slower socioeconomic development and worse mental health jointly contribute to the disability and mortality burdens of diabetes. It is imperative to promote mental health alongside economic and social development to address the public health challenge of type 2 diabetes.

Early onset type 2 diabetes (T2D) is increasingly recognized as a significant public health concern, leading to more severe complications and a greater decline in quality of life compared to T2D diagnosed later in life. This can have a profound impact on the workforce. Social status-whether assessed vertically through levels of income, education or job position or horizontally through occupational groups-can play a critical role in the risk of developing early onset T2D. While research focusing on vertical socioeconomic inequalities related to T2D is abundant, there is currently no study that combines both vertical and horizontal perspectives to explore vulnerable groups. We aim to combine the vertical and horizontal approaches to examine vulnerable groups within the employed population regarding early onset T2D. Using data from the largest statutory health insurance provider in the state of lower Saxony, Germany for the year 2019 "Allgemeine Ortskrankenkasse Niedersachsen" (AOKN), we examined education and income inequalities in early onset T2D among nine occupational sectors using logistic regression analyses (N = 365059). Age and gender adjusted prevalence rates as illustrated by predicted probabilities were displayed to compare rates of early onset T2D among different education and income levels and occupational groups. Regression tree analysis was used to examine intersectionality between the vertical (levels of income and education) and the horizontal (occupational sector) dimensions in order to determine the most vulnerable groups. Both vertical and horizontal inequalities in early onset T2D exist within the employed population. On the one hand, disparities in education and income were present across various occupational sectors. On the other hand, significant differences in T2D prevalence could be observed within the same education and income levels across different sectors. Notably, affiliation to occupational sector was the primary factor influencing vulnerability to early onset T2D, followed by educational attainment. Individuals with low education working in the "Transport, logistics, protection and security" and "Health, social work, teaching, and education" sectors were among the most vulnerable. It is important to simultaneously examine both vertical and horizontal dimensions of inequalities to identify vulnerable groups within the workforce. Future research should adopt this approach while also exploring other populations and health outcomes.

Type 2 diabetes mellitus (T2DM) is a major global public health challenge driven by a complex interplay of genetic, environmental, and social factors. This review highlights the effects of social determinants of health (SDOH) on T2DM in Asia, where rapid urbanization, worsening air pollution, and distinct socioeconomic structures uniquely influence disease outcomes. Key SDOH domains, socioeconomic status (education, income, and occupation), physical environment, food environment, healthcare access, and social context, were analyzed for their associations with T2DM prevalence, progression, and management. Among these, environmental and lifestyle shifts have emerged as particularly influential factors in Asia. Air pollution, particularly fine particulate matter, has been increasingly linked to insulin resistance and diabetes risk in Asian populations. Additionally, rapid urbanization and changing food environments contribute to rising T2DM incidence through shifts in lifestyle and dietary patterns. Across the diverse healthcare systems of Asian countries, primary care remains a universally critical component in addressing T2DM issues. Additionally, social capital and cohesion serve as protective factors, whereas social isolation heightens vulnerabilities. These insights underscore the importance of addressing SDOH in public health strategies to combat T2DM in Asia. Future research should prioritize longitudinal studies and culturally tailored interventions to reduce the region's diabetes burden.

Diabetes mellitus (DM) is a significant public health issue in Jordan. While several studies have investigated the biological and behavioural determinants' influence on diabetes mellitus incidence, prevalence and outcomes, few studies investigated socioeconomic factors. Moreover, the available Jordan-based literature lacks an investigation of the influence of socioeconomic factors on diabetes outcomes. This research seeks to evaluate the incidence of DM among the adult population of Jordan and examine the influence of significant socioeconomic variables.

The research team used the 2017-2018 Jordanian Demographic and Health Survey of individuals aged 40 and older. We used self-reported data to assess the prevalence and onset of diabetes. Descriptive and inferential analyses assessed the association between diabetes and the extracted socioeconomic variables.

Of the 21 860 extracted records, 3443 (15.8%) were related to diabetic patients. Approximately, 60% of those who were diagnosed with DM were in the 40-59 years age range. Statistically significant associations were found between the prevalence of DM and socioeconomic factors. Older age and low educational attainment were significantly associated with a higher prevalence of DM. The wealth index and residential location were also significantly associated with DM prevalence.

The study findings emphasise the need for specifically tailored and delivered public health interventions targeting individuals with challenging socioeconomic factors such as older age and low educational attainment. Healthcare providers and policymakers should focus on delivering and sponsoring educational and awareness programmes to promote self-care and the adoption of health-seeking lifestyle behaviours and practices among unprivileged and at-risk local communities. Healthcare authorities could initiate community-based diabetes screening programmes targeting marginalised and at-risk groups.

Health inequities are a significant issue. This study aimed to measure and decompose socioeconomic inequality in the utilization of type 2 diabetes (T2D) services and propose solutions to mitigate these inequalities.

This explanatory sequential mixed-method study was conducted in two phases: quantitative and qualitative. A total of 2000 T2D patients from health centers, hospitals, and diabetes clinics in Isfahan and Khuzestan provinces, Iran, were selected. In the quantitative phase, the existence of inequality in the utilization of T2D services was examined using the Concentration Index (CI) approach. To determine the contribution of each explanatory variable to T2D inequality, we used concentration index decomposition analysis. In the qualitative phase, based on the main contributors identified in the quantitative phase, we conducted semi-structured interviews with purposefully selected key experts to identify solutions for reducing inequality in the utilization of T2D services.

The sample consisted of 65.3% men, with 40% of T2D patients being over 60 years old. The CI values were 0.31 (p < 0.05) for outpatient services, -0.10 (p > 0.05) for inpatient services, and 0.11 (p < 0.05) for pharmaceutical services. This indicates an inequality in the utilization of outpatient and pharmaceutical services among T2D patients, while the inequality in inpatient services was not significant. The main variables contributing to inequality in outpatient services were health status (33.54%), basic insurance (27.43%), and socioeconomic status (24.08%). For pharmaceutical services, the contributing variables were health status (22.20%), basic insurance (13.63%), and socioeconomic status (34.35%). Experts' solutions to reduce socioeconomic inequalities in Iran were classified into three main themes: socioeconomic status, health status, and basic insurance, with 29 sub-themes.

The results suggest that targeted health interventions for poor T2D patients are recommended. Efforts towards universal coverage in outpatient care and commonly used pharmaceutical items, such as: Antidiabetic Drugs, Triglyceride Control Drugs, Cardiovascular Drugs, Neuropathy Drugs, and Nephropathy Drugs, should be considered.

Data are limited on composite cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2DM). This study aims to identify disparities in cardiovascular risk factor control based on most recent recommendations and relationships to social determinants of health in a large-scale real-world cohort of US adults.

We analyzed data from 88,416 participants with T2DM in the NIH Precision Medicine Initiative All of Us Research Program 2018-2022. We investigated the management of five key cardiovascular risk factors-glycated hemoglobin (HbA1c), LDL cholesterol (LDL-C), body mass index (BMI), blood pressure (BP), and smoking status. Statistical methods included Chi-square tests for categorical comparisons, t-tests for mean differences, and multiple logistic regression to assess the impact of demographic and socioeconomic factors on risk factor control.

The study revealed low risk factor control with only 27.7 % of participants achieving recommended levels for three or more risk factors (RFs) and 4.9 % for four or more RFs. Overall, while 81.0% were at target for HbA1c, only 37.9% were at target for BP and 10.4% for LDL-C. Notably, only 1.9 % and 6.9 % were at target for HbA1c, LDL-C, and BP together, based on current and prior recommendations, respectively. Significant disparities were observed across race/ethnicity, sex, and socioeconomic lines with 43.1 % of Asian participants at control for ≥3 RFs compared to 21.1 % of non-Hispanic black participants. In logistic regression analysis, factors such as higher income, higher educational attainment, and health insurance were associated with better RF control, while higher polysocial risk scores linked to poorer control.

Despite some progress in managing individual CVD risk factors in T2DM, overall composite risk factor control remains poor, especially among underrepresented and socioeconomically disadvantaged groups. The findings highlight the necessity for integrated healthcare strategies that address both medical and social needs to improve control of CVD risk factors and outcomes in T2DM.

Evidence regarding the associations between co-exposure to multiple metals and diabetes risk was scarce. This study aimed to evaluate the associations of multiple metals with diabetes risk using multiple statistical methods. This cross-sectional study included 192 diabetic patients and 189 healthy subjects. We employed inductively coupled plasma mass spectrometry (ICP-MS) to determine the plasma concentrations of 18 metals. Least absolute shrinkage and selection operator (LASSO) regression, logistic regression, and Bayesian kernel machine regression (BKMR) were applied to evaluate associations of multiple metals with diabetes risk comprehensively. These models consistently suggested that aluminium and selenium were positively associated with diabetes risk, while manganese, rubidium, and lead were negatively associated with diabetes risk. Age-specific differences of selenium and sex-specific differences of manganese in diabetes risk were also observed based on stratified analyses. According to RCS analyses, we obtained dose-response relationships between metals and diabetes risk:(1) there were inverted U-shaped associations of plasma aluminium and selenium with diabetes risk, with the threshold close to 20.5µg/L and 75.9µg/L, respectively (both P for overall < 0.05; both P for non-linearity < 0.05). (2) There were L-shaped associations of rubidium and lead with diabetes risk, with the turning point close to 144.5µg/L and 2.5µg/L, respectively (both P for overall < 0.05; both P for non-linearity < 0.05). (3) Manganese was linearly and negatively correlated with diabetes risk when concentrations of manganese were less than approximately 4.2 μg/L (P for overall < 0.05; P for non-linearity = 0.268). The BKMR model also revealed a negative combined effect of metal mixtures on diabetes risk and potential interactions between six pairs of metals (aluminium-manganese, aluminium-selenium, aluminium-rubidium, aluminium-lead, manganese-selenium, and manganese-rubidium). In summary, we need to pay attention to the role of low plasma levels of aluminium, selenium, manganese, rubidium, and lead in diabetes, especially regarding their safety windows.

The risk factors for type 2 diabetes mellitus (T2DM) have been increasingly researched, but the lack of systematic identification and categorization makes it difficult for clinicians to quickly and accurately access and understand all the risk factors, which are categorized in this paper into five categories: Social determinants, lifestyle, checkable/testable risk factors, history of illness and medication, and other factors, which are discussed in a narrative review. Meanwhile, this paper points out the problems of the current research, helps to improve the systematic categorisation and practicality of T2DM risk factors, and provides a professional research basis for clinical practice and industry decision-making.

The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0-2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1-1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

Despite persistent disparities in diabetes prevalence among racial and ethnic minorities, there remains a significant lack of understanding regarding the intersectionality of racial and ethnic groups and socioeconomic status (SES) with diabetes.

The data came from the National Health and Nutrition Examination Survey (NHANES; N = 30,754, mean age = 47.4) using cross-sectional survey cycles from 2007 to 2008 through 2017-2020. Diabetes status was self-reported by physician diagnosis. Sociodemographic factors included racial and ethnic groups and SES. Weighted Poisson models were used to examine the association of racial and ethnic groups and SES with diabetes, stratified by age groups (20-44, 45-64, 65-79), sex, and racial and ethnic groups for SES, separately.

Non-Hispanic Black, Hispanic, and other adults had a 47 %, 31 %, and 76 % higher prevalence of diabetes than non-Hispanic White adults, while adults from low and middle SES compared to high SES had a 37 % and 22 % higher prevalence of diabetes. Non-Hispanic Black, Hispanic, and other adults aged 45-64 years had a 45 %, 34 %, and 78 % higher prevalence of diabetes, and low and middle SES had a 57 % and 32 % higher prevalence of diabetes. Similar patterns were observed for adults aged 65-79. Males among non-Hispanic Black, Hispanic, and other adults and females from low and middle-SES families had a higher prevalence of diabetes.

Minority groups, middle and older-aged adults, males from minority groups, and females from low SES had a greater prevalence of diabetes. Effective interventions should prioritize tailoring efforts to specific minoritized and low SES groups to address diabetes disparities.

The prevalence of diabetes is rising around the world and represents an important public health concern. Unlike individual-level risk and protective factors related to the etiology of diabetes, contextual risk factors have been much less studied. Identification of contextual factors related to the risk of type 1 and type 2 diabetes in Organisation for Economic Co-operation and Development (OECD) countries may help health professionals, researchers, and policymakers to improve surveillance, develop policies and programs, and allocate funding.

Among 4,470 potential articles, 48 were included in this review. All reviews were published in English between 2005 and 2023 and were conducted in over 20 different countries. This review identified ten upstream contextual risk factors related to type 1 and type 2 diabetes risk, including income, employment, education, immigration, race/ethnicity, geography, rural/urban status, built environment, environmental pollution, and food security/environment. The ten upstream contextual risk factors identified this review may be integrated into diabetes research, surveillance and prevention activities to help promote better outcomes for people at risk or living with diabetes in OECD countries. Additional research is needed to better quantify the measures of associations between emerging key contextual factors and diabetes outcomes.

The increasing specialization and dispersion of healthcare systems have led to a shortage of resources to address comorbidities. Patients with coexisting mental and physical conditions are disadvantaged, as medical providers often only focus on the patient's mental illness while neglecting their physical needs, resulting in poorer health outcomes.

This study aimed to shed light on the systemic flaws in healthcare systems that contribute to suboptimal health outcomes in individuals with comorbid diseases, including depression and diabetes. This paper also discusses the clinical and economic benefits of collaborative methods for diagnosing and treating depressive disorders in primary care settings.

A comprehensive literature review of the relationship between depression and diabetes was conducted. The outcomes of the literature review were carefully analyzed. Several databases were searched using keywords such as "diabetes," "depression," "comorbidity," "prevalence," "epidemiology," and "risk factors" using Google Scholar and PubMed as search engines. The review and research papers written between 1961 and 2023 were our main focus.

This study revealed improved depressive symptoms and better blood sugar and blood pressure control. Additionally, individuals with comorbid depression and diabetes have higher direct and secondary medical costs. Antidepressants and psychological interventions are equally effective in treating depressive symptoms in patients with diabetes, although they have conflicting effects on glycemic control. For individuals with comorbid diabetes and depression, clear care pathways, including a multidisciplinary team, are essential for achieving the best medical and mental health outcomes.

Coordinated healthcare solutions are necessary to reduce the burden of illness and improve therapeutic outcomes. Numerous pathophysiological mechanisms interact with one another and may support the comorbidities of T2DM, and depressive disorders could exacerbate the course of both diseases.

Disparities in access to healthcare has been implied before in Finland, a country with universal healthcare but de facto tiered primary care. Less is however known about the content of care provided in different settings. Previous studies indicate potential disparities in prescribing newer medicines between healthcare sectors. We compared the preceding prescribing patterns of patients who initiated a sodium-glucose co-transporter 2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) analogue in public, occupational, and private healthcare.

We used logistic models and patient-level register data from the city of Oulu, Finland, during 2014-2018. Among patients who initiated SGLT2 inhibitors or GLP-1 analogues, we studied whether it was a first-line treatment or if other antidiabetic medicines preceded the use. In addition, prior use of statins (a lipid-lowering medicine) and insulins were studied. Clinical guidelines for type 2 diabetes recommend in most cases metformin in first-line, and insulin only at later stages or in case of severe hyperglycaemia. Using a lipid-lowering medicine is typically recommended for all.

The examined novel antidiabetic medicines were seldom initiated in first-line, and no significant differences were observed for preceding statin use across sectors, net of patient characteristics. However, patients in the public sector were more likely to have used insulin previously compared to patients in occupational sector.

Before the initiation of the examined novel antidiabetic medicines, no marked differences across sectors in the use of other antidiabetic medicines or statins were observed. The higher likelihood of prior insulin use in the public sector might reflect initiation at a later stage and/or unobserved differences in clinical characteristics across patient populations.

Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR).

We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared.

514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented.

In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

Although Hepatitis C virus (HCV) infection can be cured with direct-acting antivirals (DAA), some cured patients face a serious risk of advanced liver damage and early mortality. In order to avoid these two negative health outcomes, it is important to identify and assess related risk factors. Little is currently known about socioeconomic and behavioural factors in this context. Using data from the ANRS CO22 Hepather cohort, we tested for associations between socioeconomic and behavioural factors and (i) advanced liver fibrosis (defined as an FIB-4 > 3.25) assessed longitudinally using a mixed-effects logistic regression model (both the whole population and stratified on advanced liver fibrosis status at the time of HCV cure) and (ii) all-cause mortality (Cox proportional hazards model), during post-HCV cure follow-up. Among 5833 participants cured of HCV, living in poverty was associated with postcure advanced liver fibrosis in participants without this diagnosis at the time of HCV cure (population attributable fraction-PAF-of 8.6%) and with mortality in the whole study population (PAF of 10.6%). The detrimental effects of unhealthy alcohol use and heavy tobacco smoking, as well as the beneficial effect of living with a stable partner were also highlighted. We highlighted the major role of poverty and behavioural factors in advanced liver fibrosis and all-cause mortality in patients cured of HCV. Encouraging linkage to social support services and healthy behaviours after successful DAA treatment could limit morbidity and increase survival in this population. Clinical Trial Registration: ClinicalTrials.gov: NCT01953458.

Gestational diabetes mellitus (GDM) is a common pregnancy complication. Studies have shown that the prevalence of GDM is rising worldwide. In this study, we aimed to describe the prevalence of GDM in Ontario, Canada, between 2015 and 2021.

Population-based linked health-care administrative databases were used to identify women with GDM via a validated algorithm. Age-standardized GDM prevalence was described for each year between 2015 and 2021. Crude GDM prevalence trends were stratified according to age and income, and trend over time was evaluated using negative binomial regression.

Crude GDM prevalence was 9.5% within this period, with age-standardized prevalence increasing by 35% over the duration of the study (p<0.0001). Prevalence declined in the first year of the COVID-19 pandemic, but it rose again the next year. Prevalence was directly associated with age (p<0.0001) and inversely associated with income (p=0.04), but these disparities did not change over time.

GDM prevalence is rising, but the transient decline in the first year of the pandemic may reflect forgone GDM screening. Disparities in prevalence by age and income are not worsening. GDM is creating a growing burden for the health-care system, particularly for lower income individuals.

Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires.

Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels.

Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function.ClinicalTrials registration: NCT03693521.

Disparities in the development of Type 2 Diabetes (T2D) are associated with various social determinants, including sex/gender, migration background, living arrangement, education, and household income. This study applied an intersectional perspective to map social disparities and investigate intersectional effects regarding the onset of T2D among older adults across Europe.

We used data from the Survey of Health and Retirement in Europe (SHARE) to conduct an Intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (I-MAIHDA) of T2D onset. Individuals aged 50 years or older without known T2D at Wave 4 (2011, baseline) were included and followed through Waves 5 (2013), 6 (2015), 7 (2016), and 8 (2019-2020). Intersectional models were used to estimate additive main effects of sex/gender, migration background, living arrangement, education level, and household income and intersectional interactions.

A total of 39,108 individuals were included (age at baseline M = 65.18 years (SD = 9.62), 57.4% women). T2D onset was reported for 9.2% of the sample over the 9-year observation period. In the fully adjusted model, all social determinants showed significant additive associations with T2D onset, while the discriminatory accuracy of the social strata was found to be low (Variance Partition Coefficient = 0.3%).

This study provides a comprehensive mapping of intersectional disparities in onset of T2D among older adults in Europe. The results highlight the risk heterogeneity within the population and show social disadvantages faced by certain groups. However, while the T2D risks were higher in some strata than in others, the intersectional effects were small overall and mostly attributable to the additive main effects. The results suggest that public health strategies to prevent T2D should be universal but tailored to meet the specific situation of the different intersectional strata.

To compare the likelihood of being prescribed an antidepressant in depressed individuals with and without type 2 diabetes.

We performed a matched cohort study using primary care record data from the UK Clinical Practice Research Datalink. We used multivariable logistic regression to compare antidepressant prescribing during the first five years of starting oral antidiabetic medication to a comparison group without type 2 diabetes, matched based on GP practice, age and sex. We performed subgroup analyses stratified by sex, age and ethnicity.

People with type 2 diabetes and depression were 75% less likely to be prescribed an antidepressant compared to people with depression alone (odds ratio (OR) 0.25, 95% confidence interval (CI) 0.25 to 0.26). This difference was greater in males (OR 0.23, 95% CI, 0.22 to 0.24), people older than 56 years (OR 0.23, 95% CI, 0.22 to 0.24), or from a minoritised ethnic background (Asian OR 0.14, 95% CI 0.12-0.14; Black OR 0.12, 95% CI 0.09-0.14).

There may be inequalities in access to antidepressant treatment for people with type 2 diabetes, particularly those who are male, older or from minoritised ethnic backgrounds.

Strong oral language and reading skills are important for child development. The response to intervention (RTI) framework supports schools to apply evidence-based practices and interventions to proactively meet the learning needs of all students and identify and support students at risk of learning difficulties. Getting it Right from the Start (GIRFTS) aims to implement a codesigned RTI framework in the first 2 years of formal schooling (foundation and grade 1) to improve oral language and reading skills. GIRFTS includes an implementation evaluation.

GIRFTS is a stepped-wedge cluster randomised trial conducted in Victoria, Australia, over 3 years. Clusters are primary schools. The intervention is to implement tiers 1 and 2 of the RTI framework into foundation and grade 1 according to RTI principles. The primary outcome is reading comprehension by the start of grade 2. Secondary outcomes include listening comprehension, word and non-word reading and phonological awareness. An implementation evaluation will also be conducted with the study to understand schools' RTI implementation process and enablers and barriers to implementation. Strategies used by schools to overcome implementation challenges will also be investigated.

This trial was approved by the Royal Children's Hospital Human Research Ethics Committee (HREC/58832/RCHM-2019). Investigators will communicate the results to stakeholders, collaborators and participating schools and teachers through presentations and publications.

ISRCTN91164066, ACTRN12622000146796.

Type 2 diabetes (T2D) is a common chronic disease that disproportionally affects groups with a low socioeconomic position (SEP). This study aimed to examine associations between childhood SEP and incident T2D, independent of adult SEP.

Longitudinal data from The Maastricht Study were used (N=6,727, 55.2 % female, mean (SD) age 58.7(8.7) years). Childhood SEP was determined by asking for the highest completed educational level for the father and mother and childhood income inadequacy. Adult SEP was determined by highest completed educational level, equivalent household income, and occupational position. Incident T2D was self-reported yearly (up to 12 years of follow-up). Associations were studied with Cox regression analyses.

In participants without T2D at baseline, 3.7% reported incident T2D over 8.2 (median) years of follow-up. Incident T2D was most common in people with low childhood and adult SEP and lowest in those with high childhood and adult SEP (1.7 vs. 7.5 per 1,000 person years). The association between childhood SEP and incident T2D was mainly explained by adult SEP, except for childhood income inadequacy which was independently associated with incident T2D.

Socioeconomic inequalities in childhood and adulthood are risk factors for incident T2D. More attention is needed to reduce childhood poverty and improve adult SEP to reduce the T2D risk.

This study investigates the interplay between socioeconomic position (SEP), the residential food environment, walkability, greenspace, and type 2 diabetes (T2D), particularly whether the environmental factors mediate the association between SEP and T2D.

SEP, T2D status, residential Food Environment Healthiness Index (FEHI), number of fast-food outlets (FF), walkability index (WI), and proportion of greenspace (GS) were ascertained in 9188 participants. The associations between SEP, the environment and T2D were modeled with logistic regression and survival analysis. The proportion of mediation of the association between SEP and T2D was estimated with causal mediation analysis.

Lower SEP was associated with higher risk of T2D. Hazard ratios (HR) were 2.03 (95 % CI 1.60-2.58), 1.79 (1.40-2.30) and 1.77 (1.21-2.58) for an interquartile range decrease (IQR) of education, income, and occupation, respectively. HRs for IQR changes of the environmental factors were: FEHI 1.20 (1.00-1.43), FF 0.87 (0.76-0.99), WI 1.23 (0.95-1.58) and GS 1.16 (0.96-1.43). Regression on prevalent T2D yielded similar results. Lower socioeconomic position was associated with a less healthy environment (e.g., FEHI -0.10 (-0.12--0.07) for education). Environmental exposures mediated between 0.1 % (-0.7-0.9) and 2.6 % (0.4-5.2) of the cross-sectional associations and 0.3 % (-8.6-8.6) and 8.5 % (2.3-27.4) of the longitudinal associations.

People with lower SEP had higher risk and prevalence of T2D and lived in a slightly less healthy residential environment. The association between SEP and T2D is not strongly mediated by FEHI, FF, WI, or GS.

Type 2 diabetes (T2D) is a global health burden, more prevalent among individuals with attention deficit hyperactivity disorder (ADHD) compared to the general population. To extend the knowledge base on how ADHD links to T2D, this study aimed to estimate causal effects of ADHD on T2D and to explore mediating pathways.

We applied a two-step, two-sample Mendelian randomization (MR) design, using single nucleotide polymorphisms to genetically predict ADHD and a range of potential mediators. First, a wide range of univariable MR methods was used to investigate associations between genetically predicted ADHD and T2D, and between ADHD and the purported mediators: body mass index (BMI), childhood obesity, childhood BMI, sedentary behaviour (daily hours of TV watching), blood pressure (systolic blood pressure, diastolic blood pressure), C-reactive protein and educational attainment (EA). A mixture-of-experts method was then applied to select the MR method most likely to return a reliable estimate. We used estimates derived from multivariable MR to estimate indirect effects of ADHD on T2D through mediators.

Genetically predicted ADHD liability associated with 10% higher odds of T2D (OR: 1.10; 95% CI: 1.02, 1.18). From nine purported mediators studied, three showed significant individual mediation effects: EA (39.44% mediation; 95% CI: 29.00%, 49.73%), BMI (44.23% mediation; 95% CI: 34.34%, 52.03%) and TV watching (44.10% mediation; 95% CI: 30.76%, 57.80%). The combination of BMI and EA explained the largest mediating effect (53.31%, 95% CI: -1.99%, 110.38%) of the ADHD-T2D association.

These findings suggest a potentially causal, positive relationship between ADHD liability and T2D, with mediation through higher BMI, more TV watching and lower EA. Intervention on these factors may thus have beneficial effects on T2D risk in individuals with ADHD.

according to the World Health Organization (WHO), Non-Communicable Diseases (NCD) were a major cause of death in 2022 accounting for 4 million (74%) of deaths worldwide. Diabetes mellitus and hypertension are the two illnesses that are not contagious but linked closely. The objective of the research was to establish the prevalence and risk factors of undiagnosed diabetes among patients with hypertension attending St. Orsola Hospital in Tharaka Nithi County, Kenya.

the study utilized a descriptive cross-sectional design with random sampling. Data were collected from 384 patients with hypertension attending outpatient medical from October to December 2022 using a structured questionnaire. Analysis was conducted using the Statistical Package for the Social Sciences (SPSS). The chi-square test was used at the bivariable level and multiple logistic regression at the multivariable level, with a significance level set at P<0.05.

the findings revealed that the age of the participants ranged between 20-89 years, with majority (62%) being below 60 years, where of these participants (66%) were women. Seventy-five percent (288/384) of participants were found to be with no diabetes, with 21 (5.5%) with undiagnosed diabetes mellitus and 75 (19.5%) being pre-diabetes. Significant associations were found between diabetes status and socio-demographic factors, with higher body mass index (BMI > 24.9) showing a strong correlation with undiagnosed diabetes (AOR 3.794 95% CI: 1.345-4.705). Education level was also significant, with lower education levels (primary or below) associated with a higher risk of undiagnosed diabetes (AOR 1.821 95% CI: 2.134-8.567). Employment status played a critical role, with unemployed individuals more likely to have undiagnosed diabetes (AOR 2.845 95% CI: 1.211-6.683). Additionally, lower frequency of vegetable consumption (less than three times per week) was linked to a higher likelihood of undiagnosed diabetes (AOR 2.937 95% CI: 1.135-7.602). Gender disparities were evident, with 62% of undiagnosed diabetes cases occurring in women. These findings underscore the importance of addressing both socio-economic and behavioral factors in the prevention and management of undiagnosed diabetes among patients with hypertension.

the study highlights a substantial prevalence of undiagnosed diabetes among patients with hypertension. These findings underscore the need for integrated screening programs, targeted health education, and lifestyle modification interventions.

Hospitalization of patients with DKA creates a significant burden on the US healthcare system. While previous studies have identified multiple potential contributors, a comprehensive review of the factors leading to DKA readmissions within the US healthcare system has not been done. This scoping review aims to identify how access to care, treatment adherence, socioeconomic status, race, and ethnicity impact DKA readmission-related patient morbidity and mortality and contribute to the socioeconomic burden on the US healthcare system. Additionally, this study aims to integrate current recommendations to address this multifactorial issue, ultimately reducing the burden at both individual and organizational levels.

The PRISMA-SCR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) was used as a reference checklist throughout this study. The Arksey and O'Malley methodology was used as a framework to guide this review. The framework methodology consisted of five steps: (1) Identify research questions; (2) Search for relevant studies; (3) Selection of studies relevant to the research questions; (4) Chart the data; (5) Collate, summarize, and report the results.

A total of 15 articles were retained for analysis. Among the various social factors identified, those related to sex/gender (n = 9) and age (n = 9) exhibited the highest frequency. Moreover, race and ethnicity (n = 8) was another recurrent factor that appeared in half of the studies. Economic factors were also identified in this study, with patient insurance type having the highest frequency (n = 11). Patient income had the second highest frequency (n = 6). Multiple studies identified a link between patients of a specific race/ethnicity and decreased access to treatment. Insufficient patient education around DKA treatment was noted to impact treatment accessibility. Certain recommendations for future directions were highlighted as recurrent themes across included studies and encompassed patient education, early identification of DKA risk factors, and the need for a multidisciplinary approach using community partners such as social workers and dieticians to decrease DKA readmission rates in diabetic patients.

This study can inform future policy decisions to improve the accessibility, affordability, and quality of healthcare through evidence-based interventions for patients with DM following an episode of DKA.

Health education is integral to cardiometabolic disease (CMD) management. This study aimed to assess whether and how education preferences have changed over time, and whether trends differ by sociodemographic characteristics (education status, age, ethnicity, and sex).

A cross-sectional questionnaire was deployed across five counties in the East Midlands, UK between 2017 and 2022 to adults with CMD (type 2 diabetes, cardiovascular disease or cerebrovascular disease). Respondent demographic data were collected alongside health education preferences. Statistical analyses ascertained whether demographic characteristics influenced preferences. The distribution of preferences over time was charted to identify trends.

A total of 4301 eligible responses were collected. Face-to-face one-to-one education was preferred (first choice for 75.1% of participants) but popularity waned over the five-year period. Trends were similar amongst demographic groups. Online education showed a U-shaped trend: In 2017, 44% of respondents ranked it as acceptable, peaking at 53% in 2019, but declining again, to below base line, 43%, by 2022. This modality was more popular with participants aged younger than 65 years, but popularity in people older than 65 years increased over the study period. The popularity of printed information also declined over time across all demographic groups except those of South Asian ethnicity, for whom it remained static.

The overwhelming preference for face-to-face one-to-one health education from a doctor or nurse highlights the importance of preserving access to this modality, even in the face of current NHS pressures and trends towards digitalisation. Trends are changing, and should continue to be monitored, including between different sociodemographic groups.

Background Type 2 diabetes mellitus (T2DM) is a worldwide health issue impacting millions of individuals. In recent years, bone has been identified as an endocrine organ that regulates glucose metabolism by the release of osteocalcin, an osteoblast-specific hormone, which affects fat accumulation and blood glucose levels. Osteocalcin has been associated with insulin sensitivity and glucose control. Objective The study investigates the relationship between circulating osteocalcin levels with glycemic control parameters and insulin resistance in T2DM patients. Methods A total of 234 subjects were recruited, including T2DM patients (n=117) and age-sex-matched controls (n=117). Fasting blood samples were collected to measure fasting blood sugar (FBS), insulin, glycated hemoglobin (HbA1c), and osteocalcin levels. Osteocalcin levels were determined using an enzyme-linked immunosorbent assay. Insulin resistance was calculated using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Results The levels of osteocalcin in T2DM patients were significantly lower (7.07 ± 3.80 ng/mL) than in healthy controls (20.41 ± 13.50 ng/mL, p<0.0001). A significant negative correlation was observed between osteocalcin and HbA1c (r=-0.710, p<0.01), as well as between osteocalcin and FBS (r=-0.676, p<0.01). T2DM patients also showed significantly higher insulin resistance, as evidenced by their elevated HOMA-IR scores (4.39 ± 1.95 vs. 3.62 ± 1.82, p=0.002). There was a negative correlation between osteocalcin and HOMA-IR (r=-0.324, p=0.0001). Conclusion This study shows that osteocalcin levels are significantly reduced in patients with T2DM and demonstrate a negative correlation with HbA1c, FBS, and insulin resistance.

Individuals of working age spend a significant amount of time at the workplace making it an important context for disease prevention and management. The temporal development and prevalence of T2D have been shown to differ in the working population based on gender, age group and occupational sector regardless of socioeconomic status. Given potential differences in risk factors associated with different work environments, this study aims to define vulnerable occupational groups by examining T2D severity and its trends in working men and women with T2D of two age groups and among nine occupational sectors.

The study is based on claims data of the statutory health insurance provider AOKN. The study population consisted of all insured working individuals with T2D. T2D severity was measured using the adapted diabetes complications severity index-complication count (DCSI-CC). Mean DCSI-CC scores were calculated over four time periods between 2012 and 2019 for men and women of the age groups 18-45 and 46+ years and among nine occupational sectors. Trends of DCSI-CC were investigated using ordinal logistic regression analyses to examine the effect of time-period on the odds of having higher DCSI scores.

Overall, there was a significant rise in T2D severity over time in working men and women of the older age group. Moreover, the study displayed occupational sector differences in T2D severity and its trends. Over all, working men of all sectors had higher DCSI-CC scores compared to working women. Individuals working in the sector "Transport, logistics, protection and security" and "Construction, architecture, measuring and building technology" had higher T2D severity, while those working in the "Health sector, social work, teaching & education" had relatively lower T2D severity. There was a gender-specific significant increase over time in T2D severity in the above-mentioned occupational sectors.

The study displayed gender, age group and occupational sector differences in T2D severity and its trends. Working individuals could thus benefit from personalized prevention interventions that consider occupational contexts. As a next step, examining T2D trends and severity in specific occupations within the vulnerable occupational sectors is needed.

Education has been shown to be positively associated with cognitive performance. However, the pathways via lifestyle-related disease through which education is related to cognitive performance have not been sufficiently explored. Diabetes is an important lifestyle-related disease with increasing prevalence worldwide. Low education is associated with an increased risk of developing diabetes, while diabetes may also lead to a deterioration in cognitive performance. This study aims to explore if the associations between education and cognitive function is mediated by the diabetes status among older adults.

The data utilized in this study were derived from the first two waves of the Dutch Lifelines Cohort Study (2006-2015). The analyzed sample included 26,131 individuals aged 50 years or above at baseline. The baseline assessment included measurements of educational attainment (exposure) and the potential mediator diabetes. The outcome of cognitive function was assessed using age-standardized reaction times from the psychomotor function and attention tasks, as measured by the Cogstate Brief Battery. The Cogstate Brief Battery was only conducted at the follow-up assessment, not at the baseline assessment. Faster reaction times correspond to higher cognitive performance. The study employed linear and logistic regression models, in addition to a causal mediation approach which estimated the average causal mediation effect (ACME).

Higher education was associated with a lower risk of diabetes (b= -0.1976, 95%CI= -0.3354; -0.0597) compared to low or middle education as well as with faster reaction times (b= -0.2023, 95%CI= -0.2246; -0.1798), implying better cognitive function. Diabetes was associated with slower reaction times (b = 0.0617, 95%CI = 0.0162; 0.1072). Most importantly, the mediation approach identified a significant indirect effect of education on cognitive function via the diabetes status (ACME= -0.00061, 95%CI= -0.00142; -0.00011).

The findings emphasize the potentially importance of diabetes in explaining the role of education in promoting healthy cognitive function and mitigating the risk of cognitive decline. Early detection and treatment of diabetes may be particularly beneficial for individuals with low or middle levels of education in order to maintain good levels of cognitive function.