Table 3.

Integration of risk factors and life-course stages in women with T2DM.

Life stage	Key hormonal/metabolic vulnerability	Exacerbating risk factors	Example outcomes
Puberty	Insulin resistance, PCOS	SES, built environment, food insecurity	Early obesity, T2DM onset
Pregnancy	GDM, PIH	Limited prenatal care, stress, poor diet	Future T2DM, HTN, CVD
Menopause	Estrogen decline, visceral fat	Pollution, stress, low SES	Dyslipidemia, vascular aging
Aging	Frailty, polypharmacy	Cumulative pollution, isolation	Cognitive decline, CVD events