An Ethical Framework for Addressing the Differential Impact of Systemic Racism and Inequities on Type 1 and Type 2 Diabetes Mellitus in Youth in the United States
Year: 2025
Type: article
Abstract: BACKGROUND: Inequities in the clinical care and health outcomes of youth and young adults (YYAs) with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) are well-established. Systemic and institutional racism and barriers, as well as implicit biases underlie these inequities in the USA. SUMMARY: This article offers a broad overview and analysis of disparities in clinical care and outcomes among YYAs with T1D and T2D, framed within an ethical context. We argue that achieving ethical care requires centering assessments of patient and family needs within the realities of their lived experiences, as well as structural barriers and challenges. We examine the impact of structural racism and implicit bias on clinical care and explore how factors such as non-English language communication, literacy, numeracy, nutrition, school nursing services, access to diabetes technology and medications, and insurance disparities influence diabetes management and outcomes. The article concludes with a call to action and concrete recommendations to address and reduce these inequities. KEY MESSAGES: Clinicians can play a pivotal role in reducing diabetes-related healthcare disparities by adopting an ethical approach that centers upon lived experiences of YYA with diabetes thereby identifying opportunities for more equitable care.
Source: Hormone Research in Paediatrics
DOI: 10.1159/000548527
Institutions: University of North Carolina at Chapel Hill, Pennsylvania State University, Massachusetts General Hospital, Children's National, George Washington University, New York Medical College, University of Colorado Anschutz, University of Colorado Denver, Boston Children's Hospital, Harvard University, Nationwide Children's Hospital, The Ohio State University, Children's Hospital of Philadelphia, University of Pennsylvania, University of Southern California, Children's Hospital of Los Angeles
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: G353509602, G713621388, I: Penn State Institutional Career Development Core, Developing a patient-centered psychoeducational tool to realize the potential of diabetes technologies, Optimizing Use of Continuous Glucose Monitoring (CGM) to Advance Health Equity Among Youth with Type 1 Diabetes (T1D)
OpenAlex ID: W4414350708