• Shivani Agarwal, Alisha N Wade, Jean Claude Mbanya, Chittaranjan Yajnik, Nihal Thomas, Leonard E Egede, Jennifer A Campbell, Rebekah J Walker, Louise Maple-Brown, and Sian Graham.
• Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: shivani.agarwal@einsteinmed.edu.
• Lancet. 2023 Jul 15; 402 (10397): 235249235-249.

AbstractDiabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.Copyright © 2023 Elsevier Ltd. All rights reserved.

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