Evidence map›Paper›PMID 35482055›Full record

ArticleDiabetologia2022

Mediators of the association between educational attainment and type 2 diabetes mellitus: a two-step multivariable Mendelian randomisation study.

Jia Zhang, Zekai Chen, Katri Pärna, Sander K R van Zon, Harold Snieder, Chris H L Thio

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetologia, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 6 pooled it
14.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 6 syntheses or guidelines pooled it, 82 citations in OpenAlex.

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  19. Causal relationship and mediating role between depression and cognitive performance.The journal of prevention of Alzheimer's disease · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 3 countries.

Jia ZhangDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0001-9982-9983
Zekai ChenDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0003-2536-4532
Katri PärnaDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0002-0013-6077
Sander K R van ZonDepartment of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0002-1956-1225
Harold SniederDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.ORCID https://orcid.org/0000-0003-1949-2298
Chris H L ThioDepartment of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. c.h.l.thio@umcg.nl.ORCID https://orcid.org/0000-0003-2623-7172
University Medical Center Groningen · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aims/hypothesisType 2 diabetes mellitus is a major health burden disproportionately affecting those with lower educational attainment (EA). We aimed to obtain causal estimates of the association between EA and type 2 diabetes and to quantify mediating effects of known modifiable risk factors.

methodsWe applied two-step, two-sample multivariable Mendelian randomisation (MR) techniques using SNPs as genetic instruments for exposure and mediators, thereby minimising bias due to confounding and reverse causation. We leveraged summary data on genome-wide association studies for EA, proposed mediators (i.e. BMI, blood pressure, smoking, television watching) and type 2 diabetes. The total effect of EA on type 2 diabetes was decomposed into a direct effect and indirect effects through multiple mediators. Additionally, traditional mediation analysis was performed in a subset of the National Health and Nutrition Examination Survey 2013-2014.

resultsEA was inversely associated with type 2 diabetes (OR 0.53 for each 4.2 years of schooling; 95% CI 0.49, 0.56). Individually, the largest contributors were BMI (51.18% mediation; 95% CI 46.39%, 55.98%) and television watching (50.79% mediation; 95% CI 19.42%, 82.15%). Combined, the mediators explained 83.93% (95% CI 70.51%, 96.78%) of the EA-type 2 diabetes association. Traditional analysis yielded smaller effects but showed consistent direction and priority ranking of mediators. CONCLUSIONS/

interpretationThese results support a potentially causal protective effect of EA against type 2 diabetes, with considerable mediation by a number of modifiable risk factors. Interventions on these factors thus have the potential of substantially reducing the burden of type 2 diabetes attributable to low EA.

Indexed as

Diabetes Mellitus, Type 2Educational StatusMendelian Randomization AnalysisGenome-Wide Association StudyHumansNutrition SurveysPolymorphism, Single NucleotideRisk FactorsEducational attainmentMediationMendelian randomisationType 2 diabetes

Identifiers

PMID35482055
PMCPMC9283137
OpenAlexW4225083948

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.