Poor mental wellbeing is one of the leading causes of long-term sickness absence from work and may lead to absenteeism, presenteeism and staff turnover, costing UK employers an estimated £51 billion annually. This study uses economic modelling to provide data on costs and benefits to employers who are considering implementing a workplace intervention to improve wellbeing. Additionally, the analysis is used to assess any changes in employee outcomes (e.g., productivity and staff turnover). A cost-consequence model with a one-year time horizon was developed to assess the impact of workplace mental wellbeing interventions. Because all workplaces are different, it is not useful to present one single base case to generalise across all settings. Instead, the model generates a series of hypothetical case studies, with varying levels of absenteeism, presenteeism and staff turnover, as well as different levels of productivity and staff replacement costs. Several mental wellbeing interventions are compared with 'no intervention' (current practice) to calculate the total incremental costs and incremental cost per employee. In a hypothetical case study with 50 employees and an intervention cost of £100, the intervention has a net cost saving of £4,207 per employee. Savings are due to reductions in absenteeism and presenteeism. Sensitivity analysis and scenario analysis assess the impact of varying each input, to reflect that inputs will vary substantially for each individual organisation and setting. The intervention is more likely to be cost saving when the baseline levels of absenteeism, presenteeism and staff turnover are high, and the intervention cost is low. Mental wellbeing interventions may influence a range of outcomes, but outcomes demonstrating a mental wellbeing benefit to employees may be challenging to translate into monetary value. The model can be used by decision makers and employers to understand the potential economic and wellbeing implications of implementing workplace mental wellbeing interventions.

BACKGROUND:To quantify inequalities in obesity-related complication (ORC) prevalence and differences in healthcare costs between the most (Q1) and least (Q5) deprived quintiles of people living with obesity. METHODS:Retrospective, open cohort study of ~2.5 million people residing in North-West London using linked primary and secondary electronic health records. Individuals aged ≥18 years living with obesity (body mass index ≥30 kg/m2) between 1 January 2016 and 31 December 2019 were eligible. The population was stratified into deprivation quintiles per the Index of Multiple Deprivation (IMD). Individuals were grouped into non-mutually exclusive ORC prevalence groups covering 27 ORCs, including ORC multimorbidity. Primary outcomes were ORC prevalence and healthcare cost differences between the lowest and the highest deprivation quintiles. ORC prevalence and healthcare costs were age-standardised to the European Standard Population. RESULTS:Out of 362 023 people living with obesity, 64 866 were in IMD Q1 (most deprived) and 24 590 in Q5. The largest ORC prevalence differences between Q1 and Q5 were seen in conditions with highest prevalence overall: type 2 diabetes (5.1 percentage point prevalence difference; 19.5% prevalence), hypertension (3.8, 32.7%) and depression (3.4, 6.3%). The percentage point prevalence difference was larger with increasing ORC multimorbidity: 1.2 for at least one, 3.7 for at least two and 4.0 for at least three ORCs. Healthcare costs were greater in the most deprived quintile compared with the least deprived quintile for every ORC population, with the largest differences seen in peripheral arterial disease (£2801 cost difference), cancer (£2785), renal failure (£2108). CONCLUSIONS:Targeted interventions proportionate to these health and cost burdens could improve health equity and reduce healthcare cost, yet their causal drivers require further study.

Background Vitamin D lowers the risk of type 2 diabetes in adults with prediabetes. We assessed the long-term cost-effectiveness of vitamin D supplementation for preventing type 2 diabetes. Methods We applied a validated microsimulation model to estimate long-term health and economic consequences of vitamin D in a representative cohort of 10,000 U.S. adults with prediabetes in the National Health and Nutrition Examination Survey (NHANES) 2013-2018 cohort. Treatment effects came from individual-participant data of three randomised trials of vitamin D versus placebo (D2d, USA, 2013-2018; DPVD, Japan, 2013-2019; Troms & oslash;, Norway, 2008-2015: pooled analysis 2023). Cost-effectiveness was measured by an incremental cost-effectiveness ratio (ICER) in terms of cost per quality-adjusted life year (QALY) compared to no vitamin D. We conducted subgroup analyses by age, baseline fasting glucose level, body weight, and family history of diabetes. We performed one-way and probabilistic sensitivity analysis. Costs were in 2024 U.S. dollars. 10-year and lifetime time horizons were studied from a U.S. health care system perspective. Findings In a NHANES-derived cohort of 4176 adults with prediabetes (mean age 53.3 years [SD 17.0); 2024 [49%] female: 2603 [62%] non-Hispanic White, 488 [12%] non-Hispanic Black, 668 [16%] Hispanic, 417 [10%] other race/ethnicity), vitamin D supplementation reduced per-person lifetime costs by $3208 (95% uncertainty interval [UI]-$5974 to $171), increased lifetime QALYs by 0.12 (95% UI 0.05-0.19), and yielded a lifetime net monetary benefit of $15,483 (95% UI $8108-$21,907) at a willingness-to-pay threshold of $100,000/QALY. Life-years gained were 0.27 per person (95% UI 0.06-0.50). Vitamin D reduced the lifetime cumulative incidence of diabetes by 8% (95% UI 6.4-10.6%). Diabetes complications were reduced by an average of 6.4% (95% UI 3.2-8.7%). There were little differences in ICERs across subgroups. Changes in intervention-related parameters had limited effects on the cost-effectiveness ratios across sensitivity analyses, and the intervention likewise remained cost-saving compared to no vitamin D under all simulation scenarios. Interpretation Vitamin D supplementation may be an efficient use of health care resources for preventing type 2 diabetes in adults with prediabetes.

Introduction People with type 2 diabetes (T2D) have a higher dementia risk. Cardiometabolic factors may influence dementia development, but long-term links among people with T2D remain unclear. Prior studies show mixed findings and have not considered how the time before dementia diagnosis at which cardiometabolic factors are measured affects their association with dementia risk.Methods We examined the associations between eight routinely measured cardiometabolic factors (including blood pressure, lipid, and glycemic markers) and the risk of dementia in 249 958 adults with T2D from the Clinical Practice Research Datalink (1999–2018). Multivariable Cox proportional hazards regression was applied with age as the timescale and stratified by follow-up time at 5, 5–10, and ≥10 years before dementia diagnosis. Cardiometabolic factors were analyzed continuously and categorically using clinically relevant cut-offs.Results 22 492 incident dementia cases were observed (1 257 998 person-years of follow-up). Higher systolic blood pressure was associated with a lower dementia risk, particularly when measured closer to the time of dementia diagnosis. Higher diastolic blood pressure (DBP) (90 vs 80 mm Hg) was associated with a 21% greater risk of dementia (95% CI 15% to 27%). Dementia risk was 32% (27%–36%) lower for those with a body mass index (BMI) ≥30 (vs <25 kg/m2) when measured within 5 years of dementia diagnosis, but 15% (7%–23%) and 43% (31%–56%) higher if measured 5–10 and ≥10 years before diagnosis, respectively. Higher levels of glycemic measures were consistently associated with a greater dementia risk. Findings for total cholesterol and low-density lipoprotein were largely null.Conclusions Higher DBP, BMI, and glycemic measures measured over 10 years before dementia diagnosis were linked to a greater dementia risk among adults with T2D. Associations varied depending on when cardiometabolic factors were measured relative to dementia diagnosis, demonstrating the importance of distinguishing potential long-term risk factors from short-term markers of dementia development.

BACKGROUND:Incidence of multiple long-term conditions (MLTCs), or multimorbidity, is inconsistently defined and infrequently reported at whole-population level. We aimed to measure the MLTC incidence and progression rates, examining the interaction between ethnicity and socioeconomic deprivation, using routinely collected health-care data covering the adult population of England, UK. METHODS:Using the National Segmentation Dataset, we measured incidence of 28 long-term conditions, that align with the Delphi consensus for the definition of MLTCs in research, among adults aged 20 years and older in England between April 1, 2022, and March 31, 2023. We defined MLTC progression rate as the incidence of events in which disease burden progresses through the acquisition of one or more long-term conditions. We measured this over a longer 6-year period, identifying adults aged 20 years and older acquiring their first or second long-term condition between April 1, 2017, and March 31, 2018, and measuring the MLTC progression rate to March 31, 2023. Cox proportional hazard regression was used to examine sociodemographic associations. FINDINGS:Among 49·6 million adults between April 1, 2022, and March 31, 2023, conditions occurring as a first condition with the highest incidence were depression (1088 [95% CI 1085-1092] cases per 100 000 person-years), hypertension (885 [882-888]), cancer (525 [522-528]), diabetes (464 [462-466]), asthma (440 [438-443]), osteoarthritis (394 [392-396]), coronary heart disease (252 [250-254]), and cerebrovascular disease (196 [194-197]). These accounted for 78·5% of all first conditions. Of 1 092 728 people acquiring their first and 535 661 their second conditions between April 1, 2017, and March 31, 2018, median follow-up time was 5·16 years (IQR 2·58-5·50) and 4·41 years (IQR 1·33-5·41), respectively. Progression rate per 100 person-years was 8·56 (95% CI 8·53-8·58) from one condition to two or more conditions and 13·60 (13·55-13·65) from two conditions to three or more conditions. Among those aged 40-49 years at baseline, the progression rate from two to three or more conditions (9·48 [9·36-9·60]) was 46% higher than one to two or more conditions (6·48 [6·42-6·53]). Proportional hazards models showed progression from one to two or more conditions was highest in the most deprived quintile (hazard ratio [HR] 1·37 [1·36-1·39]; p<0·0001 compared with least deprived) and the Black ethnic group (HR 1·19 [1·11-1·29]; p<0·0001 compared with the White ethnic group), and lower in females (HR 0·95 [0·94-0·95]; p<0·0001 compared with males). Negative interaction coefficients between Black ethnicity and most deprived quintile (index of multiple deprivation quintile 1) showed a reduced association between progression and deprivation within the Black ethnic group (HR 0·78 [0·72-0·85]; p<0·0001). INTERPRETATION:In this whole-population study of adults in England, eight long-term conditions (ie, depression, hypertension, cancer, diabetes, asthma, osteoarthritis, coronary heart disease, and cerebrovascular disease) account for the majority of the first conditions people acquire. The presence of existing conditions is associated with higher MLTC progression rate. Socioeconomic deprivation is strongly associated with progression, apart from in the Black ethnic group in which progression is high across all intersectional ethnicity and deprivation subgroups, highlighting the importance of intersectional approaches in public health policy and research. FUNDING:None.

Background:Early-onset type 2 diabetes is associated with aggressive disease progression, long-term health burden and reduced life expectancy. Trends in incidence have not been comprehensively described. Methods:Using data from the English National Diabetes Audit, age-standardised incidence rates for adults with type 2 diabetes were calculated by age, sex, and ethnicity between 2011 and 2024. Poisson regression models were created to study incidence over time. Annual change in median BMI within 26 weeks of diagnosis were calculated. Findings:Age-standardised incidence increased among adults aged 20-29 years (RR 1.021 [95% CI 1.017-1.026] per year in males, 1.030 [1.026-1.034] in females) and 30-39 years (1.013 [1.012-1.015] in males, 1.03 [1.028-1.032] in females). Incidence increased minimally in males aged 40-59 years (1.006 [1.005-1.006]), was rising in females (1.018 [1.017-1.019]) and declined in males and females aged 60-79 years (0.983 [0.983-0.984] in males, 0.985 in females 0.985 [0.984-0.985]). Increasing incidence in young adults were observed in all sex and ethnicity subgroups except Asian males (20-39-years) but highest rates were in White females (30-39-years) and Black females (20-29). BMI at diagnosis increased in all subgroups over time but was highest in younger adults and higher in females than males. The annual change in younger adults was double that of older (20-29 year-old-males +0.17 kg/m2/year [0.08-0.26] and females +0.17 [0.09-0.26]; 30-39-year-old males +0.21 [0.18-0.24] and females +0.20 [0.16-0.24]; 40-59 year-old-males +0.06 [0.04-0.07] and females +0.09 [0.06-0.12]; 60-79 year old males +0.08 [0.06-0.09] and females +0.11 [0.08-0.13]). Interpretation:Since 2011, incidence of type 2 diabetes has risen significantly in young adults across most ethnicity and sex subgroups (especially females) despite minimal changes or declining rates at older ages. This trend parallels greater increases in BMI-at-diagnosis in young people, highlighting a shift in disease burden and the urgent need for earlier prevention, and focused obesity interventions in early-life. Funding:Wellcome Trust.

Several transitions, or new patterns and dynamics in the contributors and health outcomes, have altered the character and burden of the multi-decade, worldwide growth in prevalence of type 2 diabetes (T2DM). These changes have led to different needs for prevention and care. These dynamics have been driven by diverse demographic, socio-economic, behavioural, and health system response factors. In this Perspective, we describe these transitions and how their attributes have set the stage for multimorbidity, or multiple long-term conditions (MLTCs), to be the next major challenge in the diabetes epidemic. We also describe how the timing and character of these stages differ in high-, middle-, and low-income countries. These challenges call for innovation and a stronger focus on MLTCs across the spectrum of cause, effectiveness, and implementation studies to guide prevention and treatment priorities.

Existing evaluations of the National Health Service Diabetes Prevention Programme (NHS DPP) in England have demonstrated associated reductions in body weight, hemoglobin A1c and incident type 2 diabetes (T2D). In this study, we examined associations between completion of the NHS DPP and incidence of T2D and 30 other long-term conditions (LTCs), including LTCs considered linked to the program's interventional goals of body weight reduction, increased physical activity and improved diet quality (LTC-L) and LTCs considered to be possibly linked to those goals (LTC-PL). We found that completers of the NHS DPP had lower incidences of T2D, LTC-L and LTC-PL compared to non-attenders. Although these associations attenuated over time, they remained significant for all outcomes at 24 months with an odds ratio of 0.53 (95% confidence interval: 0.48-0.59) for T2D and rate ratios of 0.79 (0.74-0.84) and 0.80 (0.74-0.88) for LTC-L and LTC-PL, respectively. However, we were not able to directly conclude whether lower incidence rates were a direct result of completing the NHS DPP or due to residual bias stemming from unmeasured confounding and imprecision in the estimation of diagnosis.

CONTEXT:There is large variation in the individual risk of developing obesity-associated comorbidities. While obesity is highly prevalent in Mexico, data on the extent and heterogeneity of its associated comorbidities are lacking. OBJECTIVE:We estimated the prevalence of different obesity-associated comorbidities, and how they have changed over 15 years. METHODS:We gathered data from different editions of nationally representative health and nutrition surveys (ENSANUT) from 2006 to 2022. The prevalence of obesity and the coexistence with diabetes, dyslipidemia, hypertension, depression, and impaired mobility, which are outcomes used in the Edmonton Obesity Staging System (EOSS), which assesses 3 dimensions (medical, mental, and functional) across 5 incremental severity stages, by sex and age groups, were estimated across all included surveys. Metabolically healthy obesity (MHO) was defined as the absence of diabetes, dyslipidemia, and hypertension. RESULTS:A total of 20 758 participants were analyzed. Mean body mass index (BMI) increased progressively at all ages from 30.2 to 31.0 across survey rounds. Depression and impaired mobility were highly prevalent even among MHO individuals. While most people with obesity had at least one detectable abnormality, there was large heterogeneity in the presented comorbidities. The most prevalent EOSS categories were stage 2 for the medical dimension (90.1%), and stage 1 for the functional and mental dimensions (75.1% and 62.9%, respectively). The prevalence of obesity-related comorbidities increased with age but was similar across all surveys. In both sexes, MHO was less likely as age and BMI increased. CONCLUSION:The prevalence of obesity comorbidities has been stable over time in Mexico but increases with age. The rising prevalence of obesity and the aging of the population will cause additional burdens to the population and the health system.

Little is known about the association between low- and no-calorie sweetened (LCS) product consumption and children’s dietary quality, despite the promotion of these products as sugar alternatives. This study examines the trends and associations between LCS product consumption and intakes of free sugar, ultra-processed food and beverages (UPFB), and other key dietary components among UK children. Repeated annual cross-sectional data from the National Diet and Nutrition Survey (2008/09-2018/19) for children aged 4–18 years (N = 5,922) were analysed. Children were categorized into No-LCS (0

BACKGROUND:With the increasing global burden of type 2 diabetes, prevention strategies that target prediabetes, a state of hyperglycaemia that puts individuals at high risk of type 2 diabetes, are required. We aimed to estimate global rates of transition from prediabetes to normoglycaemia or type 2 diabetes, stratified by age, sex, and race and ethnicity. We also aimed to quantify the effect of modifiable and non-modifiable risk factors on these transitions. METHODS:In this pooled analysis of individual-level data, we included original data from 19 prospective cohort studies conducted in Asia (Iran and Japan), Australia, Europe (Spain and Sweden), North America (USA and Mexico), and South America (Venezuela). We applied discrete-time hidden Markov models to estimate rates and ratios of prediabetes transitions to type 2 diabetes and normoglycaemia specific to age, sex, and race and ethnicity. We used Fine-Gray competing risk models to derive cohort-specific subhazard ratios (SHRs) for potential risk factors influencing these transitions. We subsequently pooled these SHRs using a random-effects meta-analysis. In subgroup analyses stratified by age, sex, race and ethnicity, and recruitment period, we used multivariate Cox models to investigate the degree of heterogeneity between studies. FINDINGS:76 092 participants (39 842 [52·3%] women and 36 250 [47·6%] men; mean age 51·1 years [SD 12·7]) with available data on glycaemic status from at least one follow-up visit were included in the analysis, of whom 56 837 (74·7%) had normoglycaemia and 19 255 (25·3%) had prediabetes. Median follow-up was 9·8 years (IQR 5·8-12·5). Within 10 years, individuals with prediabetes had a 12·5% probability of progressing to type 2 diabetes, whereas the probability of reverting to normoglycaemia was 36·1%. However, in the highest fasting plasma glucose quartile, the probability of progression increased to 16·1% and reversion decreased to 13·4%. Male sex, older age (≥55 years), and Latinx populations were associated with an increased risk of transitioning to type 2 diabetes. Risk factors that significantly reduced prediabetes reversion to normoglycaemia were overweight (SHR 0·88 [95% CI 0·76-0·99]), obesity (0·66 [0·52-0·81]), elevated waist-to-height ratio (0·82 [0·70-0·95]), elevated waist-to-hip ratio (0·79 [0·68-0·91]), and reduced HDL concentration (0·72 [0·59-0·84]). INTERPRETATION:Our findings highlight that reversion to normoglycaemia was more common than progression to type 2 diabetes among individuals with prediabetes, and that these transitions were strongly influenced by modifiable risk factors. The increased risk of progression with advancing age and among men underscores the importance of early identification and targeted interventions in population groups at high risk of type 2 diabetes. Furthermore, the elevated progression risk in individuals with higher fasting plasma glucose concentrations at baseline reinforces the need for timely detection and intervention during this crucial clinical window. FUNDING:Deakin University Postgraduate Research Scholarship.

AIMS:Diabetic foot ulcer disease (DFUD) is common, life-changing and associated with a lower 5-Year survival rate than many cancers. However, the risk factors for DFUD have generally been identified in small, single-centre, clinic-based studies, many of which are cross-sectional. This study aims to assess the incidence of DFUD and its related risk factors in two large, contemporary UK cohorts. MATERIALS AND METHODS:We investigated common sociodemographic and clinical factors affecting the incidence rates of DFUD in two large representative independent cohorts of people with diabetes in England (CPRD, n = 131 042) and Scotland (Scottish Diabetes Research Network-National Diabetes Dataset [SDRN-NDS] n = 260 748). The methods of case ascertainment differed between the two cohorts: in England, both primary and secondary care data were used, whereas in Scotland, secondary care and foot clinic data were used. RESULTS AND CONCLUSIONS:In the English cohort, 4.7% developed DFUD over a median of 4.3years (incidence rate 9.0[95%CI: 8.8-9.2] per 1000 person-years) follow-up; in the Scottish cohort, the equivalent figure was 2.9% over a median of 6.3 years (incidence rate 4.4 [95% CI: 4.3-4.5] per 1000 person-years). Despite different methods of case ascertainment, multivariable analysis in both populations indicated that those who developed DFUD were more likely to be older, male, smokers, of White ethnicity, with higher systolic blood pressure and baseline HbA1c. These findings provide a robust evidence base for identifying people with diabetes at risk of DFUD for targeted efforts for prevention.

The incidence of early-onset type 2 diabetes is increasing, with a growing number of cases now occurring in children, adolescents, and young adults. This transition is primarily driven by the rising prevalence of obesity in younger populations, especially in high-income countries. However, the relationship between obesity and early-onset type 2 diabetes varies across ethnic groups, with some populations exhibiting a higher risk at lower BMI thresholds, possibly due to differences in insulin resistance and β-cell function. Socioeconomic factors further shape disease patterns, with early-onset type 2 diabetes disproportionately affecting lower-income populations in high-income settings, whereas in low-income and middle-income countries, economic development and urbanisation have contributed to increasing incidence among more affluent groups. The consequences of this transition to early-onset type 2 diabetes are severe, with accelerated disease progression, heightened risks of microvascular and macrovascular complications, and considerable societal and health-care burdens compared with later-onset disease. Given the continuing rise in childhood and adolescent obesity, the incidence of early-onset type 2 diabetes is expected to increase further, placing mounting pressure on health-care systems worldwide. In the first of three papers in this Series, we examine global trends in the incidence and prevalence of early-onset type 2 diabetes, identify key drivers of this transition to diagnosis at younger ages, and review the evidence for risk factors both at population and individual level.

Background Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization. Methods This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants. Findings The final output consisted of 81 validated indicators—22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings. Interpretation This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness. Funding This study was funded internally by WHO.

BACKGROUND:In the United Kingdom, the prevalence of diabetes-related foot ulcer disease (DFUD) is 6.3%, and cardiovascular disease (CVD) is the leading cause of mortality in people with DFUD. This study aims to evaluate the effectiveness of a multifactorial intervention to reduce CVD events and mortality in adults with type 2 diabetes (T2D) and DFUD. METHODS:The MiFoot study is a multi-centre, pragmatic randomised controlled trial to test intervention effectiveness and cost-effectiveness compared to usual care that will include an internal feasibility study and a process evaluation. English-speaking adults (≥18 years; n = 392) with T2D and current/previous (within 5 years) DFUD will be recruited from multiple sites across the United Kingdom and randomised 1:1 to intervention (MiFoot multifactorial intervention plus usual care) or control (usual care), with data collected at baseline, 12- and 24-month follow-up. The MiFoot intervention comprises an individualised assessment with a healthcare practitioner to optimise treatment and assess the suitability of physical activity participation; group-based disease self management education and physical activity sessions; and a digital-based programme, consisting of cohort-relevant topics, physical activity guidance and peer support functionality. The primary outcome will be extended major adverse cardiovascular events (MACE, i.e. myocardial infarction, stroke, cardiovascular death, peripheral arterial bypass, coronary artery bypass, coronary angioplasty or peripheral artery angioplasty) at 24 months. DISCUSSION:This study will provide evidence on the feasibility and clinical effectiveness, and cost-effectiveness of a multifactorial intervention to prevent or slow the progression of CVD-related complications in the extremely high-risk population with T2D and DFUD.

AIMS:To investigate whether the association between type 2 diabetes diagnosis and relative and absolute risk of obesity-related cancers differs based on age at diabetes diagnosis. METHODS:This retrospective, observational cohort study used data from the US Collaborative Network within the TriNetX database. Individuals with type 2 diabetes were propensity matched - for age, sex, and ethnicity - to individuals without type 2 diabetes. Crude 5-year risks of obesity-related cancer were calculated. Cox proportional-hazards models were used to assess relative rates of obesity-related cancer incidence over five years, comparing individuals with type 2 diabetes in younger (aged ≤40 years; n = 162,691) and middle-older age (aged >40 years; n = 1,616,950), with propensity-matched cohorts without type 2 diabetes. RESULTS:Absolute risk of developing cancer was greater in individuals with versus without type 2 diabetes. Relative rates of any cancer were greater in younger (HR: 2·01 [95 % CI: 1·85, 2·19]) than middle-older age adults (1·49 [1·48, 1·51]). The highest relative rates in younger adults were observed for corpus uteri (HR: 4·76 [3·51, 6·46]) and pancreatic cancer (4·25 [2·34, 7·72]). Corresponding HRs in middle-older age adults were 1·92 (1·84, 2·01) and 1·75 (1·68, 1·83). CONCLUSIONS:The five-year risk of cancer was higher in those with newly diagnosed type 2 diabetes versus those without. Absolute risk was greater in middle-older age adults, although relative rates were greater amongst younger adults. This persisted across most site-specific cancers, suggesting targeted strategies for early detection and prevention may help younger adults with newly-diagnosed type 2 diabetes reduce lifetime disease burden.

AIMS:To assess longitudinal trends in total and cause-specific mortality rates and in hospitalisation rates for diabetes complications among people with type 2 diabetes in England between 2009 and 2019; and to assess how trends differ by patient characteristics. MATERIALS AND METHODS:A sequential cohort study of people with type 2 diabetes aged ≥20 years was performed using data from the National Diabetes Audit. Discretised Poisson regression models, adjusted for age, sex, ethnicity, socio-economic deprivation and diabetes duration, were used to calculate total and cause-specific mortality rates, as well as hospitalisation rates for myocardial infarction, stroke, heart failure, kidney and liver disease. RESULTS:Total mortality declined in people aged 20-74 years (rate ratio [RR] 0.96, 95% CI 0.95-0.97) and aged ≥75 years (0.93, 0.92-0.94) between 2009-2011 and 2018-2019, predominantly due to reductions in cardiovascular deaths. Over the same time period, in those aged 20-74 years, total mortality declined in people of South Asian (0.92:0.0.87-0.96) but was unchanged in people of White (1.00: 0.99-1.01) ethnicities. Total mortality declined more in people living in the least (0.91:0.88-0.94) compared to the most (0.97:0.95-1.00) deprived areas. A composite endpoint of cardiovascular hospitalisations and mortality increased between 2009-2011 and 2018-2019 in those aged 20-49 years (1.20:1.14-1.27) and 50-74 years (1.04:1.03-1.05) but declined in those aged ≥75 years (0.85:0.84-0.86). Rates of hospitalisation for kidney and liver disease increased in all age groups. CONCLUSIONS:By examining longitudinal trends in mortality and hospitalisations according to different characteristics in people with type 2 diabetes in England, we have identified important targets for improvement through changes in health policy and care delivery.

A large variation in diabetes prevalence by socioeconomic status (SES) persists internationally. This study aimed to quantify the prevalence of diabetes by age and SES and explore the current levels of inequality in the prevalence of diabetes in Ireland. Annual cross-sectional self-reported diabetes data from the national population-based Healthy Ireland Survey for 2015–2023 (n = 59,933) were utilised. Highest educational attainment and area-based deprivation were used as SES indicators. Additionally, the differences in diabetes prevalence across population age-groups were reported. Socioeconomic differences and change in inequality over time were quantified using the relative index of inequality (RII). Logistic regression was used to estimate the relative risk (RR) for having self-reported diabetes according to age and SES, adjusted for sex and survey year. Diabetes prevalence was highest among individuals aged > 75 years (13.1