Dysregulation of glucose metabolism by insulin is central to the development of type 2 diabetes which disproportionately affects Indigenous populations across colonised countries (1). Given the fundamental role of carbohydrate metabolism in type 2 diabetes, this review explores whether underlying differences exist in fasting and postprandial glycemic control among Indigenous populations in comparison with non-Indigenous populations in the same geographical location. Keywords relating to carbohydrates, glycemic response and Indigenous peoples were used to search MEDLINE (OVID), Embase, Cochrane CENTRAL and Scopus. Eligible studies included comparative observational and cross-sectional studies that reported on blood glucose or insulin levels over at least 2 hours in response to a defined dietary carbohydrate. Study subjects were required to be non-diabetic and > 18 years of age. Studies were excluded if the comparator population did not reside in the same country or had not lived there for more than 10 years. Reference lists of studies meeting inclusion criteria were subsequently screened. A modified 9-point Newcastle-Ottawa criteria for cross-sectional studies was utilised for assessing risk of bias. Due to study heterogeneity, scarcity and moderate risk of bias, meta-analysis was not possible. The 15 eligible studies provided consistent evidence that in response to ingestion of carbohydrate, postprandial insulin responses are greater and often accompanied by a greater or more prolonged postprandial glucose response in Indigenous populations. This is indicative of prolonged glucose availability and heightened insulin responsiveness, reflecting inherent population-level differences in metabolic regulation. However, the available evidence displayed a moderate level of bias, reflecting the lack of current, high-quality research in this under-explored topic. The protocol for this systematic review was registered with PROSPERO (CRD420261413978).