Diabetes Research and Clinical Practice · Nov 9, 2026

Global spatial distribution and risk factor profiles of Co-occurring type 2 diabetes and ischemic heart disease across 204 countries and territories

By Tian Q, Yang F, Chen B et al.

Background Type 2 diabetes (T2D) and ischemic heart disease (IHD) interact reciprocally and contribute to massive global multimorbidity burden. This study aimed to map global T2D-IHD co-occurrence patterns and quantify key risk factors to support targeted integrated prevention. methods We extracted incidence data of T2D and IHD and exposure data of 58 risk factors for adults aged ≥ 25 years across 204 countries and territories in 2021 GBD. SHAP machine learning and negative binomial regression were applied to screen independent risk factors, and population-attributable fractions (PAFs) and a composite risk index were calculated to evaluate attributable disease burden. Results Among 204 countries and territories, 36.27% were consistent, 32.84% T2D-dominant and 30.88% IHD-dominant. Six key risk factors were identified, including two shared metabolic risks (high body mass index, kidney dysfunction), one T2D-specific (high fasting plasma glucose), and three IHD-specific risks (low temperature, high systolic blood pressure, diet low in whole grains). Collectively, cumulative exposure to the three T2D-related factors explained 22.98% of global T2D cases, while the five IHD-related factors explained 56.22% of global IHD cases. The combined PAF of these six risk factors exceeded 70% T2D and IHD cases in consistent regions. In addition, high-risk exposure areas of these factors spatially overlapped greatly with T2D and IHD hotspots. Conclusion Global T2D-IHD co-occurrence showed obvious spatial heterogeneity driven by modifiable shared and disease-specific risks. Combined interventions for common risks plus regionally targeted strategies for unique hazards are essential to alleviate their combined global health burden.

doi.org/10.1016/j.diabres.2026.113651PubMed 43003289Populations