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. 2023 Jul 15;402(10397):250-264.
doi: 10.1016/S0140-6736(23)00914-5. Epub 2023 Jun 22.

Interventions to address global inequity in diabetes: international progress

Ashby F Walker  1 , Sian Graham  2 , Louise Maple-Brown  3 , Leonard E Egede  4 , Jennifer A Campbell  4 , Rebekah J Walker  4 , Alisha N Wade  5 , Jean Claude Mbanya  6 , Judith A Long  7 , Chittaranjan Yajnik  8 , Nihal Thomas  9 , Osagie Ebekozien  10 , Oriyomi Odugbesan  10 , Linda A DiMeglio  11 , Shivani Agarwal  12
Affiliations

Interventions to address global inequity in diabetes: international progress

Ashby F Walker et al. Lancet. .

Abstract

Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.

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Conflict of interest statement

Declaration of interests AFW is supported by The Leona M and Harry B Helmsley Charitable Trust (2005-03934) and the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (5P30DK111024-07). LM-B is supported by an Australian National Health and Medical Research Council (NHMRC) investigator grant (1194698), and leads projects that are funded by NHMRC, the Australian Department of Health, and the Australian Medical Research Future Fund. LEE and JAC are supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK118038 and R01DK120861, awarded to LEE; K01DK131319, awarded to JAC). LEE and RJW are supported by the National Institute on Minority Health and Health Disparities (R01MD013826, awarded to LEE and RJW; R01MD017574, awarded to LEE). RJW is supported by the American Diabetes Association (1-19-JDF-075). ANW is supported by the National Institutes of Health-Fogarty International Centre (K43TW010698). ANW declares an honorarium received from Sanofi for serving as a panel member at an educational event on thyroid cancer. JCM receives honorarium from Servier Laboratories for serving on the advisory committee at educational events. OE is a health-care disparities adviser (on a temporary advisory board role) for Medtronic. OE has received research support through his organisation T1D Exchange from Medtronic, Vertex, Dexcom, and Eli Lilly. Medtronic supports components of T1DX-QI health equity work. The T1DX-QI is funded by The Leona M and Harry B Helmsley Charitable Trust. LAD has received research support to her institution from Dompé, Lilly, MannKind, Medtronic, Provention, and Zealand Pharma; and served as a consultant for Abata Therapeutics and Vertex. SA is supported by the National Institutes of Health-National Institute of Diabetes and Digestive Kidney Disease (R01DK132302, K23115896, and P30DK111022-07), JDRF, and The Leona M and Harry B Helmsley Charitable Trust. SA receives research devices, but not salary support from Dexcom and Abbott, and is a health-care disparities adviser (on a temporary advisory board role) for Medtronic and Beta Bionics. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:
A pragmatic action-based framework to address global inequity in diabetes
Figure 2:
Figure 2:
Corresponding levels of the social–ecological model to the recommendations of The Lancet Commission on Diabetes
Figure 3:
Figure 3:
DIABETES across the LIFECOURSE: Northern Australia Partnership
Figure 4:
Figure 4:. The Project ECHO Diabetes model
Adapted from Walker et al. ECHO=Extension for Community Healthcare Outcomes. UFDI=University of Florida Diabetes Institute.
Figure 5:
Figure 5:. PMNS and PRIYA
Generations are indicated as F0, F1, and F2. PMNS=Pune Maternal Nutrition Study. PRIYA=Pune Rural Intervention in Young Adolescents.
See this image and copyright information in PMC

References

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    1. Agarwal S, Wade AN, Mbanya JC, et al. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; published online June 22. 10.1016/S0140-6736(23)00909-1. - DOI - PMC - PubMed

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