The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
in a colombian study they showed that apoe4 by itself may not substantially increase the risk of alzheimer's disease but since diabetes is prevalent in a certain city in colombia diabetics who were apoe4 carriers had substantial increase in ad risk compared to diabetics alone or e4 carriers alone
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if you looked at it and you'd say this is a healthy colombian who's you know farming all day long lean and they have absolutely no metabolic diseases the e4 is doing nothing
type 2 diabetes I don't know the number but I think it approximately doubles your risk of Alzheimer's disease so in other words even if you're sitting there walking around with two copies of the APO E3 allele having type 2 diabetes means you might as well have a copy of an E4 allele from a risk perspective
Type 2 diabetes OR carrying one variant of the ApoE4 gene can double the risk of developing Alzheimer's disease — these are both critical factors that can act in concert or independently.