Mediators of the association between educational attainment and type 2 diabetes mellitus: a two-step multivariable Mendelian randomisation study – published online 28/04/2022

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

Higher educational attainment protects against type 2 diabetes, but the underlying mechanisms are uncertain. In this issue, Zhang et al (https://doi.org/10.1007/s00125-022-05705-6) report the results of a Mendelian randomisation study, in which they used genetic instruments to minimise bias due to confounding. Using a multivariable extension of this method, they estimated mediation between educational attainment and type 2 diabetes by the modifiable risk factors BMI, sedentary behaviour, smoking and blood pressure. They estimate that up to 84% of the protective effect of higher educational attainment is mediated by lower levels of these risk factors. The two largest mediating factors were BMI and sedentary behaviour, each individually mediating 50% of the protective effect, with partially overlapping effects. The authors conclude that these findings might inform future trials and preventive policies to reduce the burden of type 2 diabetes due to educational inequalities.

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