The forgotten - overcoming challenges in diabetes care for marginalized populations.

INTRODUCTION: Diabetes disproportionately affects marginalized populations, leading to poorer glycemic control, higher complications, and reduced quality of life. Unequal access to care, mediated by multiple social determinants of health (SDoH), further exacerbates these risks. Addressing SDoH is crucial to mitigate health disparities and downstream impacts on the United States (U.S.) population and healthcare system. AREAS COVERED: This review explores SDoH that disproportionately affect marginalized communities, including socio-economic (SE), geographic, cultural and linguistic, health literacy-related, psychologic, and systemic barriers to equitable diabetes care. We also explore evidence-based care strategies such as telehealth, social media and internet-based education strategies, integration of community health workers (CHW), integrated care models and policy changes. EXPERT OPINION: While small-scale interventions have demonstrated success in overcoming challenges in diabetes care for marginalized populations, significant research gaps remain. Studies focusing on long-term outcomes and addressing the root causes of disparities tied to SDoH are urgently needed. Furthermore, rather than merely characterizing SDoH, researchers and clinicians must actively address them at the patient, provider, and system levels. Advancing diabetes care and reducing disparities requires equity-focused policies, inclusive research, and culturally tailored interventions. Without systemic reforms, however, these advancements risk perpetuating existing inequalities.

Duke Scholars

Author Matthew Janik Crowley Medicine, Endocrinology, Metabolism, and Nutrition

Author Bryan Courtney Batch Medicine, Endocrinology, Metabolism, and Nutrition

Author Anastasia Stefania Alexopoulos Medicine, Endocrinology, Metabolism, and Nutrition

Author Maria Martinez Cruz  

Author Hayden Barry Bosworth Population Health Sciences