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

Hassan, Saria; Gujral, Unjali P.; Quarells, Rakale C.; Rhodes, Elizabeth; Shah, Megha; Obi, Jessica; Lee, W.Y.; Shamambo, Luwi; Weber, Mary Beth; Narayan, K.M. Venkat

doi:10.1016/s2213-8587(23)00129-8

Cited by 28 publications

(7 citation statements)

References 180 publications

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“…Global and Regional Variations: Research indicates that T2DM and its complications manifest differently across various regions and populations, even exhibiting multilevel disparities within the same ethnic group [ 211 ]. Addressing these issues necessitates a comprehensive research and practice framework.…”

Section: Discussionmentioning

confidence: 99%

Section: Preventive Strategies For Macrovascular Complications In Typ...mentioning

confidence: 99%

“…Moreover, the success of this program is not solely dependent on the expertise of physicians, nurses, and nutritionists; it also emphasizes active community participation and comprehensive support from the healthcare system [ 211 ]. Community involvement is crucial for tailoring preventive measures to the actual needs and cultural backgrounds of patients, thereby enhancing the acceptability and feasibility of these interventions [ 211 ]. Additionally, systemic support, including funding and training for multidisciplinary teams, enables this multilayered, multidisciplinary approach to comprehensively address the complex needs of diabetes patients in terms of quality of life, disease management, and prognosis[ 211 ].…”

Section: Preventive Strategies For Macrovascular Complications In Typ...mentioning

confidence: 99%

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Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review

Guan,

Tian,

Wang

et al. 2024

Eur J Med Res

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Type 2 diabetes mellitus (T2DM) poses a significant global health burden. This is particularly due to its macrovascular complications, such as coronary artery disease, peripheral vascular disease, and cerebrovascular disease, which have emerged as leading contributors to morbidity and mortality. This review comprehensively explores the pathophysiological mechanisms underlying these complications, protective strategies, and both existing and emerging secondary preventive measures. Furthermore, we delve into the applications of experimental models and methodologies in foundational research while also highlighting current research limitations and future directions. Specifically, we focus on the literature published post-2020 concerning the secondary prevention of macrovascular complications in patients with T2DM by conducting a targeted review of studies supported by robust evidence to offer a holistic perspective.

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Section: Discussionmentioning

confidence: 99%

Section: Preventive Strategies For Macrovascular Complications In Typ...mentioning

confidence: 99%

Section: Preventive Strategies For Macrovascular Complications In Typ...mentioning

confidence: 99%

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Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review

Guan,

Tian,

Wang

et al. 2024

Eur J Med Res

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“…This comprehensive review provides valuable insight on minority perspectives of CHWP-led interventions and shared perspectives within the general population ( 10 , 12 – 14 ). They also highlight that utilising CHWPs might mitigate some of the issues around language and culture but these interventions are still vulnerable to broader socio-economic issues that can impact attendance, and sustained engagement ( 13 , 155 ). The TFA proved a useful means of organising the data and its comprehensive structure added to the reviews methodological rigour which used best practice throughout ( 34 , 47 , 156 ).…”

Section: Discussionmentioning

confidence: 99%

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Grant,

Litchfield

2024

Front. Clin. Diabetes Healthc.

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ObjectiveEthnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.Materials and methodsThe major databases were searched for existing qualitative evidence of participants’ experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon’s Theoretical Framework of Acceptability.ResultsThe results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants’ satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.ConclusionMany of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.

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“…Differences in T2D risk across and within racial and ethnic groups 26 emerge from factors at the individual, interpersonal, community, and societal levels. 27 Youth-onset prediabetes results from a complex interplay across these levels, on an intergenerational scale.…”

Section: Discussionmentioning

confidence: 99%

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents

Harrison,

Peyyety,

Rodriguez Gonzalez

et al. 2024

JAMA Netw Open

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ImportanceSeveral clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism.ObjectiveTo evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weight status.Design, Setting, and ParticipantsThis cross-sectional study and analysis used data from the 2011 to 2018 cycles of the National Health and Nutrition Examination Survey. Data were analyzed from June 1, 2023, to April 5, 2024. Participants included youths aged 12 to 18 years with body mass index (BMI) at or above the 85th percentile without known diabetes.Main Outcomes and MeasuresThe main outcome consisted of an elevated hemoglobin A1c (HbA1c) level greater than or equal to 5.7% (prediabetes or undiagnosed presumed T2D). Independent variables included race, ethnicity, and adverse SDOH (food insecurity, nonprivate health insurance, and household income &lt;130% of federal poverty level). Survey-weighted logistic regression was used to adjust for confounders of age, sex, and BMI z score and to determine adjusted marginal prediabetes prevalence by race, ethnicity, and adverse SDOH.ResultsThe sample included 1563 individuals representing 10 178 400 US youths aged 12 to 18 years (mean age, 15.5 [95% CI, 15.3-15.6] years; 50.5% [95% CI, 47.1%-53.9%] female; Asian, 3.0% [95% CI, 2.2%-3.9%]; Black, 14.9% [95% CI, 11.6%-19.1%]; Mexican American, 18.8% [95% CI, 15.4%-22.9%]; Other Hispanic, 8.1% [95% CI, 6.5%-10.1%]; White, 49.1% [95% CI, 43.2%-55.0%]; and &gt;1 or other race, 6.1% [95% CI, 4.6%-8.0%]). Food insecurity (4.1% [95% CI, 0.7%-7.5%]), public insurance (5.3% [95% CI, 1.6%-9.1%]), and low income (5.7% [95% CI, 3.0%-8.3%]) were each independently associated with higher prediabetes prevalence after adjustment for race, ethnicity, and BMI z score. While Asian, Black, and Hispanic youths had higher prediabetes prevalence overall, increasing number of adverse SDOH was associated with higher prevalence among White youths (8.3% [95% CI, 4.9%-11.8%] for 3 vs 0.6% [95% CI, −0.7% to 2.0%] for 0 adverse SDOH).Conclusions and RelevanceAdverse SDOH were associated with higher prediabetes prevalence, across and within racial and ethnic categories. Consideration of adverse SDOH may offer a more actionable alternative to race- and ethnicity-based screening to evaluate T2D risk in youth.

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

Cited by 28 publications

References 180 publications

Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review

Advances in secondary prevention mechanisms of macrovascular complications in type 2 diabetes mellitus patients: a comprehensive review

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents

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