Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward

Abstract

Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.

Figure 1:. Conceptual framework for diabetes disparities in the USA (adapted from Agarwal et al)

Figure 2:. Type 1 and type 2 diabetes incidence per 100 000 person-years (2014–15) and prevalence per 100 000 individuals (2017): results from the SEARCH for Diabetes in Youth Study,