Health and racial disparities in diabetes mellitus prevalence, management, policies, and outcomes in the United States
Open accessAbstract
Diabetes Mellitus (DM) is a severe and chronic metabolic disorder characterized by hyperglycaemia and various complications, including cardiovascular disease. It is diagnosed when fasting plasma glucose (FPG) level is126 mg/dL (7.0 mmol/L) or higher [1]. Notable differences in DM prevalence are evident among populations in the United States. While DM affects 13% of the general adult population, specific groups, including American Indians/Alaska Natives (14.7%), Hispanics (12.5%), and non-Hispanic Blacks (11.7%), experience disproportionately higher rates. Conversely, lower prevalence rates are observed among non-Hispanic Asians (9.2%) and non-Hispanic Whites (7.5%). Black Americans are twice as likely to succumb to diabetes-related mortality compared to Whites [2]. The overall objective of this review article is to comprehensively address racial disparities in DM within the United States, emphasizing prevalence rates, management strategies, and health outcomes across diverse ethnic groups. To achieve this objective, we conducted a systematic review and meta-analysis utilizing data from nationally representative surveys, healthcare databases, and published literature spanning from 2014 to 2023. Our findings highlight significant racial disparities in DM prevalence, with minority populations, including African Americans, Hispanics, and Native Americans, consistently exhibiting higher rates than their Caucasian counterparts. Beyond prevalence, disparities extend to access to healthcare resources, diabetes education, and preventive measures. Additionally, challenges in DM management, including access to optimal treatment modalities, medication adherence, and diabetes self-management education, are identified among minority populations. Socioeconomic factors, particularly income and education, significantly contribute to these disparities. This review article contributes to the growing body of evidence guiding policymakers, healthcare professionals, and researchers in developing targeted strategies to achieve health equity in diabetes management and prevention. Addressing these disparities is crucial for fostering an inclusive and practical approach to DM care within diverse ethnic populations.
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Black patients are significantly less likely than White patients to receive GLP-1 receptor agonists and SGLT2 inhibitors even when they meet clear clinical criteria.
“Analyses from large healthcare systems, including the Veterans Health Administration, show that Black patients are significantly less likely than White patients to receive these therapies [13].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The Results and Discussions section (page not provided) reports racial disparities in diabetes management, including minority patients’ access to optimal treatment, and its Treatment of Diabetes Mellitus section identifies GLP-1 receptor agonists and SGLT2 inhibitors as therapies. It does not report a Black-versus-White prescribing comparison for those drugs, clinical eligibility, or an analysis from the Veterans Health Administration. (LLM, conf=0.84)
Experimental — accuracy not yet measuredExisting guidelines rarely address how social, racial, and economic factors influence real-world access to GLP-1 receptor agonist and SGLT2 inhibitor therapy.
“Furthermore, existing guidelines rarely address how social, racial, and economic factors influence real-world access to therapy, leaving clinicians without practical frameworks to mitigate disparities [6].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The Results and Discussions section on limited access to health insurance says coverage affects diabetes treatment and that racial and ethnic minorities experience treatment gaps. The Treatment section lists GLP-1 receptor agonists and SGLT2 inhibitors, but does not connect access disparities specifically to those drugs. The Limitations section says this review may lack actionable recommendations; it does not assess whether existing guidelines rarely address these factors or leave clinicians without practical frameworks. No page numbers were available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAccess to specialty care and modern healthcare infrastructure is a major determinant of whether patients receive GLP-1 receptor agonists and SGLT2 inhibitors.
“Access to specialty care and modern healthcare infrastructure is a major determinant of whether patients receive GLP-1 receptor agonists and SGLT2 inhibitors.”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The ‘Limited Access to Health Insurance and Healthcare’ section (page unavailable) links specialist access and healthcare resources to diabetes care and treatment. The ‘Treatment of Diabetes Mellitus’ section (page unavailable) lists GLP-1 receptor agonists and SGLT2 inhibitors, but does not say that specialty care or modern healthcare infrastructure determines whether patients receive those drugs. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIntegrating bias-awareness and equity-focused curricula into professional development improves clinicians' ability to deliver fair, individualized care that aligns clinical evidence with patient context.
“Integrating bias-awareness and equity-focused curricula into professional development improves clinicians’ ability to deliver fair, individualized care that aligns clinical evidence with patient context [6].”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The Results and Discussions section on healthcare access says culturally competent healthcare can enhance quality of life for people with diabetes, and the Conclusions call for strategies to improve equity in diabetes care (page numbers unavailable). Neither passage says that bias-awareness or equity-focused professional-development curricula improve clinicians’ ability to provide individualized care or align evidence with patient context. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIndividuals with lower socioeconomic status have lower utilization of GLP-1 receptor agonists and SGLT2 inhibitors.
“Numerous studies demonstrate lower utilization of these agents among individuals with lower income, limited educational attainment, and inadequate insurance coverage.”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The Low Income and Poverty section links lower income to reduced healthcare access, and the Limited Access to Health Insurance section reports that uninsured adults receive fewer diabetes services. Neither passage addresses utilization of GLP-1 receptor agonists or SGLT2 inhibitors; searches for both drug classes and socioeconomic differences found no passage establishing the claimed pattern. (LLM, conf=0.74)
Experimental — accuracy not yet measured
High medication costs and out-of-pocket expenses remain among the most formidable barriers to GLP-1 receptor agonist and SGLT2 inhibitor use, even for insured patients.
“High medication costs remain among the most formidable barriers to GLP-1 RA and SGLT2i use.”
From Unequal Access to Evidence-Based Cardiometabolic Therapies: Racial Disparities in SGLT2 Inhibitor and GLP-1 Receptor Agonist Use Among Patients With Type 2 Diabetes and Cardiovascular Disease (2026) · cites this paper as [6]
The Treatment of Diabetes Mellitus section identifies GLP-1 receptor agonists and SGLT2 inhibitors as treatments, while the Limited Access to Health Insurance section discusses affordability of diabetes care generally. Neither passage says medication costs are a major barrier to using those drugs; searches for medication costs and out-of-pocket expenses did not establish that point, including for insured patients. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Mapping Census Tract Clusters of Type 2 Diabetes in a Primary Care Population
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Parental Income Level and Risk of Developing Type 2 Diabetes in Youth
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Flagged first, then by citations
Research works printed but not linked: 1
- [113]Doulatyari PK, Ghahramani M, Mozaffari K (2023) Investigating the Effect of Aerobic and Resistance Training on Insulin Resistance and Some Cardiovascular Disease Risk Factors in Type 2 Diabetes Mellitus Patients: A Systematic Review. J Clin Res Paramed Sci 12: e134510.
Cited by
Sorted by citations
Obi, M. F., Ahmad, S., & Ezechukwu, K. (2026) · Cureus · doi:10.7759/cureus.106266 · Cited by 1 · see citing works
“Furthermore, existing guidelines rarely address how social, racial, and economic factors influence real-world access to therapy, leaving clinicians without practical frameworks to mitigate disparities [6].”
Influential
- Authors
- Yedjou, C. G., Sims, J. N., Njiki, S., Chitoh, A. M., Joseph, M., Cherkos, A. S., & Tchounwou, P. B.
- Affiliations
- Florida Agricultural and Mechanical University (US)
- East Texas A&M University (US)
- Jackson State University (US)
- University of North Texas Health Science Center (US)
- Morgan State University (US)
- Corresponding author
- Clément G. Yedjou
- Jennifer N. Sims
- Ariane M Chitoh
- Paul Bernard Tchounwou
- Venue
- Journal of Community Medicine & Public Health
- Publisher
- Gavin Publishers
- Published
- 2024-08-15
- Volume
- 8
- Issue
- 3
- ISSN
- 2577-2228 (ISSN-L)
- PMC
- PMC11654833
- OpenAlex
- W4401846963
- Cited by
- 19
- References
- 125
- Citations by year
- 2026: 15 · 2025: 3 · 2024: 1
- FWCI
- 6.26
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-sa
- Locations
- Journal of Community Medicine & Public Health (publishedVersion, cc-by-sa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Science Foundation (2142465)
- Jackson State University
- Morgan State University (U54MD013376)
- Florida Agricultural and Mechanical University
- National Institutes of Health (1ot2od032581-01, 3OT2OD032581, OT2OD032581)
- National Institute on Minority Health and Health Disparities (U54MD015929, U54MD013376)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes mellitus, racial disparities, health disparities, diabetes prevalence, diabetes management, diabetes self-management education, medication adherence, health care access, health equity, socioeconomic factors, diabetes mortality, minority groups, health policy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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