Prevalence of youth type 2 diabetes in global Indigenous populations: a systematic review

Emily R Papadimos^{1

2}, Courtney Claussen^{3

4}, Dianna J Magliano^{5

6}, Cheri Hotu⁷, Alex Brown^{8

9}, Odette Pearson^{10

11}, Donald Warne¹², Louise Maple-Brown^{13

14}, Baiju R Shah¹⁵, Hiliary Monteith¹⁶, Louise A Baur¹⁷, Andrew Cotterill¹⁸, Anthony J Hanley^{16

19

20}, Elizabeth L M Barr^{13

5}

Affiliations

¹ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. emily.papadimos@menzies.edu.au.
² Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia. emily.papadimos@menzies.edu.au.
³ Cheyenne River Lakota, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.
⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁷ Ngāti Maniapoto, Ngāti Ruanui, Te Toka Tumai Auckland City Hospital, Te Whatu Ora, Aotearoa, New Zealand.
⁸ Yuin Nation, National Centre for Indigenous Genomics, Australian National University, Adelaide, SA, Australia.
⁹ The Kids Research Institute Australia, Adelaide, SA, Australia.
¹⁰ Eastern Kuku-Yalanji and Zenadth Kes (Torres Strait Islander), South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia.
¹¹ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
¹² Oglala Lakota, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹³ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
¹⁴ Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
¹⁵ Department of Medicine and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
¹⁸ Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia.
¹⁹ Department of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²⁰ Leadership Sinai Centre for Diabetes, Mt. Sinai Hospital, Toronto, ON, Canada.

PMID: 41037099
DOI: 10.1007/s00125-025-06556-7

Review

Prevalence of youth type 2 diabetes in global Indigenous populations: a systematic review

Emily R Papadimos et al. Diabetologia. 2025.

. 2025 Oct 2.

doi: 10.1007/s00125-025-06556-7. Online ahead of print.

Authors

Affiliations

¹ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. emily.papadimos@menzies.edu.au.
² Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia. emily.papadimos@menzies.edu.au.
³ Cheyenne River Lakota, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA.
⁴ Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁵ Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
⁶ School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁷ Ngāti Maniapoto, Ngāti Ruanui, Te Toka Tumai Auckland City Hospital, Te Whatu Ora, Aotearoa, New Zealand.
⁸ Yuin Nation, National Centre for Indigenous Genomics, Australian National University, Adelaide, SA, Australia.
⁹ The Kids Research Institute Australia, Adelaide, SA, Australia.
¹⁰ Eastern Kuku-Yalanji and Zenadth Kes (Torres Strait Islander), South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, SA, Australia.
¹¹ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
¹² Oglala Lakota, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹³ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
¹⁴ Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
¹⁵ Department of Medicine and Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.
¹⁷ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
¹⁸ Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia.
¹⁹ Department of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
²⁰ Leadership Sinai Centre for Diabetes, Mt. Sinai Hospital, Toronto, ON, Canada.

PMID: 41037099
DOI: 10.1007/s00125-025-06556-7

Abstract

Aims/hypothesis: We aimed to synthesise global prevalence estimates of type 2 diabetes among Indigenous youth aged under 25 years, and examine age- and gender-specific differences and secular trends.

Methods: We searched MEDLINE, Embase, CINAHL and Cochrane, and bibliographies of included studies, from 1 January 1980 to 14 September 2024. We included cross-sectional observational studies that reported diabetes point prevalence estimates (per 1000) and prevalence trends in Indigenous youth aged under 25 years from all regions. Age- and gender-specific analysis and secular trends were reported. Study quality was assessed using a modified Newcastle-Ottawa Scale adapted for Indigenous health research.

Results: From 2342 records and 27 additional references, 49 studies were retained for data extraction. Total type 2 diabetes prevalence, reported in 33 of 49 studies from 36 distinct populations across six countries and two self-governing states, varied widely (0-44 per 1000), with 75% (27/36) of the populations reporting a prevalence of over 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0-4 per 1000 at age <10 years; 0-44 per 1000 at age 10-19 years; and 0-64 per 1000 at age 15-25 years. Of 22 studies with gender-specific data, 77% showed a female predominance. Secular trends, examined in 12 studies since 1981, showed a rising prevalence in young adults (aged 15-25 years) in eight of ten studies, and in youth aged under 15 years in six of nine studies. Heterogeneity in study design, diagnostic criteria, and incomplete age- and gender disaggregation precluded meta-analysis.

Conclusions/interpretation: Youth type 2 diabetes prevalence in Indigenous populations is very high, particularly in young adulthood, and among the female sex. Prevalence has increased over time. Future research should stratify data by age and pubertal status, and identify both protective and risk factors to inform targeted prevention strategies. Indigenous-led, community-specific approaches that actively engage youth are critical in the development and implementation of diabetes surveillance, prevention and management programmes.

Trial registration: PROSPERO registration no. CRD42021278418.

Keywords: Adolescent; Children; Diabetes; Health equity; Indigenous health; Paediatrics; Prevalence; Systematic review; Type 2 diabetes; Youth.

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Conflict of interest statement

Acknowledgements: The authors thank the Diabetes in Indigenous Populations Special Indigenous Group for their expertise, and the IDF Diabetes Atlas team for initiating this work. Special recognition is given to the late Laercio Joel Franco for his contributions to diabetes epidemiology and to this review, including data extraction for Brazil. Thanks go to S. Karuranga (IDF) and L. Chen (Baker Heart and Diabetes Institute) for their help with the search strategy and to L. Chen for assistance with graph interpolation. Additional thanks go to the Aboriginal and Torres Strait Islander Advisory Group of the Diabetes Across the Lifecourse Partnership at Menzies School of Health Research, who supported this work, and to A. ‘Tiwahe Iyotancilapi Win’ Warne (Oglala Lakota) for her valuable insights as a youth representative. Data availability: All data generated or analysed during this study are included in the ESM. Funding: Open Access funding enabled and organized by CAUL and its Member Institutions. ERP is the recipient of an NHMRC Postgraduate Scholarship (GNT1190866) to support her PhD candidature at Menzies School of Health Research, Charles Darwin University, Darwin, Australia. CC was a recipient of the Gates Millennium Scholarship, NW NARCH Student Support Fellowship, and RMPHTC Student Leaders in Public Health to support her PhD programme at the University of North Dakota, USA. DJM is supported by an NHMRC Investigator Fellowship L2. LM-B is supported by an NHMRC Investigator Grant (GNT1194698). HM is supported by the CIHR Banting Fellowship. OP is supported by an NHMRC Investigator Grant (GNT2026852) L2. ELMB is supported by an NHMRC Grant (GNT1194698). LAB is supported by an NHMRC Investigator Grant (GNT2009035). Authors’ relationships and activities: DJM is Chair of the Diabetes Atlas of the IDF and a member of the editorial board of Diabetologia. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work. Contribution statement: DJM conceived the project and identified internal experts for the literature search. ERP led the systematic review, reviewed bibliographies, extracted data and drafted the initial manuscript with significant input from ELMB. ERP, CC, ELMB, AJH and DJM developed the search strategy, screened abstracts and full texts, extracted and analysed data, conducted quality assessments and provided intellectual input and editing. CH, BRS and HM screened abstracts and extracted region-specific data. CH, BRS, HM, AB, OP, DW, LM-B, LAB and AC contributed to the study design, data interpretation and manuscript review. All authors had full access to the data, revised the manuscript and provided final approval of the version to be published. ERP is the guarantor of the work, ensuring data integrity and accuracy in the analysis.

References

1. Magliano DJ, Sacre JW, Harding JL, Gregg EW, Zimmet PZ, Shaw JE (2020) Young-onset type 2 diabetes mellitus — implications for morbidity and mortality. Nat Rev Endocrinol 16(6):321–331. https://doi.org/10.1038/s41574-020-0334-z - DOI - PubMed
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1. UN Permanent Forum on Indigenous Issues (UNPFII) (2015) State of the World's Indigenous Peoples, 2nd volume. Available from: https://www.refworld.org/docid/55c89dac4.html . Accessed 19 September 2022
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Prevalence of youth type 2 diabetes in global Indigenous populations: a systematic review

Affiliations

Prevalence of youth type 2 diabetes in global Indigenous populations: a systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

References

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LinkOut - more resources

Full Text Sources