Tailoring interventions to close gaps in diabetes mellitus care

Diabetes mellitus is one of the fastest-growing chronic medical conditions worldwide. It disproportionately affects some minoritized populations, including certain racial and ethnic groups, migrant populations, and rural communities. Disparities in diabetes mellitus prevalence, morbidity and mortality in minoritized populations are related to longstanding structural and social inequities and are closely tied to social factors. However, current interventions to improve diabetes mellitus outcomes among people from minoritized populations have primarily focused on trying to change individual behaviour, without sufficiently addressing the root structural barriers that drive disparities. Here, we aim to describe the structural inequities in the diagnosis, management and outcomes of minoritized people with diabetes mellitus and to discuss practical measures that can ensure equitable care for people in minoritized groups who have diabetes mellitus. Using a framework to examine diabetes mellitus disparities, we will consider interventions at system levels, including public health approaches, the endocrine healthcare workforce, care quality standards, access to high-quality care (including advanced technologies) and involvement in research. We will also discuss strategies to address intermediate factors, including food insecurity and literacy, and to improve diabetes mellitus care services among migrant and refugee populations and racial and/or ethnic minority communities.