about health equity in diabetes

BACKGROUND

 

In the United States, over 38 million Americans (11.6%) are living with diabetes, and an additional nearly 98 million are living with prediabetes(1). The incidence of diabetes is increasing in the United States across all populations. Numerous diabetes-related health inequities exist for people of various social identities, geographic locations, and socioeconomic statuses(2):

 

  • Non-Hispanic Black people with diabetes have higher A1C levels (3) and twice the mortality rate (4) compared to non-Hispanic white people with diabetes. In 2020, 48.6% of non-Hispanic Black people with diabetes experienced diabetes-related ketoacidosis (DKA), compared to 18.6% among non-Hispanic white people. (5)
  • American Indian and Alaska Native people are more likely to have diabetes than any other racial group(1).
  • Black and Hispanic people are less likely to receive SGLT2 inhibitor and GLP-1 receptor agonist medications(6).
  • Refugee and immigrant populations have a higher risk of diabetes than the general S. adult population(7).
  • Residents in distressed Appalachian counties are more likely to live with diabetes(8).
  • Non-Hispanic black women had 63% higher risk and Hispanic women and “other” racial or ethnic women had more than double the risk for developing type 2 diabetes following gestational diabetes (GDM) compared with non-Hispanic white women.(9)

 

These risks become compounded for individuals of more than one minoritized identity. Diabetes health inequities are expensive on top of an already costly disease (diabetes accounts for one of every four healthcare dollars spent)(10). For example, Deloitte’s analysis from 2022 “determined that 4.8% of spending on diabetes is associated with health disparities, which results in $15 billion in unnecessary spending(11),”  and diabetes health inequities have widened since the COVID-19 pandemic(12). Organizations increasingly identify health equity as a population health strategy. It is imperative to thoughtfully address health inequities by disseminating best practices to reduce the disproportionate impact on marginalized communities.

 

T1D Exchange and the American Diabetes Association® have partnered to host the first annual ADEPT Conference, “Achieving Diabetes Equity in Practice Today”, to amplify interventions and resources by convening health equity and diabetes stakeholders —emphasizing collective learning, showcasing emerging best practices, and facilitating the dissemination of practical, evidence-based solutions in a one-and-a-half-day conference.

 

 

REFERENCES

 

  1. National Diabetes Statistics Report: Center for Disease Control 2024 [Available from: https://www.cdc.gov/diabetes/php/data-research/index.html.
  2. Kirk JK, D’Agostino RB, Jr., Bell RA, Passmore LV, Bonds DE, Karter AJ, et al. Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care. 2006;29(9):2130-6.
  3. Karter AJ, Parker MM, Moffet HH, Gilliam LK. Racial and Ethnic Differences in the Association Between Mean Glucose and Hemoglobin A1c. Diabetes Technol Ther. 2023;25(10):697-704.
  4. Diabetes and African Americans. [Available from: https://minorityhealth.hhs.gov/diabetes-and-african-americans]
  5. Lavik AR, Ebekozien O, Noor N, Alonso GT, Polsky S, Blackman SM, et al. Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients. The Journal of Clinical Endocrinology & Metabolism. 2022;107(7):1948-55.
  6. Cai C, Woolhandler S, McCormick D, Himmelstein DU, Himmelstein J, Schrier E, et al. Racial and Ethnic Inequities in Diabetes Pharmacotherapy: Black and Hispanic Patients Are Less Likely to Receive SGLT2is and GLP1as. J Gen Intern Med. 2022;37(13):3501-3.
  7. Kumar GS, Beeler JA, Seagle EE, Jentes ES. Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review. J Immigr Minor Health. 2021;23(4):813-23.
  8. Improving Health in Appalachia: Centers for Disease Control; 2023 [Available from: https://www.cdc.gov/diabetes/health-equity/improving-health-appalachia.html.
  9. Bower JK, Butler BN, Bose-Brill S, Kue J, Wassel CL. Racial/Ethnic Differences in Diabetes Screening and Hyperglycemia Among US Women After Gestational Diabetes. Prev Chronic Dis. 2019;16:E145.
  10. Health and Economic Benefits of Diabetes Interventions: Centers for Disease Control; 2024 [Available from: https://www.cdc.gov/nccdphp/priorities/diabetes-interventions.html#cdc_generic_section_2-the-high-cost-of-diabetes.
  11. Deloitte Analysis: Health Care Costs for Average American Could Triple by 2040 if Health Inequities are Unaddressed While Annual Spending Could Exceed $1 Trillion [press release]. Deloitte2022.
  12. Lv F, Gao X, Huang AH, Zu J, He X, Sun X, et al. Excess diabetes mellitus-related deaths during the COVID-19 pandemic in the United States. EClinicalMedicine. 2022;54:101671.
  13. Ebekozien O, Mungmode A, Odugbesan O, Majidi S, Prahalad P, Noor N, et al. Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative. J Diabetes. 2022;14(1):79-82.
  14. DeSalvo DJ, Noor N, Xie C, Corathers SD, Majidi S, McDonough RJ, et al. Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study. J Diabetes Sci Technol. 2023;17(2):322-8.
  15. Ebekozien O, Odugbesan O, Rioles N, Majidi S, Jones N-HY, Kamboj M. Equitable post-COVID-19 care: a practical framework to integrate health equity in diabetes management. JCOM. 2020;27(6):256-9.
  16. Ebekozien O, Agarwal S, Noor N, Albanese-O’Neill A, Wong JC, Seeherunvong T, et al. Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers. J Clin Endocrinol Metab. 2021;106(4):e1755-e62.
  17. EBEKOZIEN O, NOOR N, KAMBOJ MK, ODUGBESAN O, MAJIDI S, HOPKINS R, et al. 167-OR: Inequities in Glycemic Outcomes for Patients with Type 1 Diabetes: Six-Year (2016–2021) Longitudinal Follow-Up by Race and Ethnicity of 36,390 Patients in the T1Dx-QI Collaborative. Diabetes. 2022;71(Supplement_1).
  18. Alonso GT, Ebekozien O, Gallagher MP, Rompicherla S, Lyons SK, Choudhary A, et al. Diabetic ketoacidosis drives COVID-19 related hospitalizations in children with type 1 diabetes. J Diabetes. 2021;13(8):681-7.
  19. Beliard K, Ebekozien O, Demeterco-Berggren C, Alonso GT, Gallagher MP, Clements M, et al. Increased DKA at presentation among newly diagnosed type 1 diabetes patients with or without COVID-19: Data from a multi-site surveillance registry. Journal of Diabetes. 2021;13(3):270-2.
  20. The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes CONFERENCE 27–30 April 2022 I BARCELONA & ONLINE. Diabetes Technology & Therapeutics. 2022;24(S1):A-1-A-237.
  21. The Official Journal of ATTD Advanced Technologies & Treatments for Diabetes Conference 22‐25 February 2023 I Berlin & Online. Diabetes Technology & Therapeutics. 2023;25(S2):A-1-A-269.
  22. Health Equity: Mary Ann Liebert, Inc., publishers; 2024 [Available from: https://home.liebertpub.com/publications/health-equity/641.