Racial/ethnic inequities in diabetes mellitus: a narrative review

Inequities in diabetes diagnosis, management, and outcomes are deeply rooted in social determinants of health and structural racism. Historical policies such as redlining and concentrated poverty in low-income neighborhoods have shaped environments characterized by limited access to healthy food and proper healthcare, which ultimately led to a disproportionate burden of diabetes in these populations. The consequences of these disparities for racial and ethnic minoritized groups include a lower ability to achieve glycemic targets, receive novel glucose-lowering agents, and/or have access to diabetes technology. The downstream effect is that this population experiences worse health outcomes from complications (i.e., amputation, blindness, end-stage renal disease) and mortality. This narrative review synthesizes current literature on racial/ethnic inequities in diabetes care, highlighting differences in screening, glycemic control, complication rates, and mortality in people living with diabetes from diverse racial and ethnic backgrounds, but also identifies opportunities for intervention to ensure equitable access to evidence-based care.