Social Determinants of Health and Diabetes

Social Determinants of Health and Diabetes

Diabetes is often thought of as a condition driven by genetics and personal lifestyle choices.While these factors play a key role, the broader social determinants of health (SDoH), conditions in which people are born, grow, live, work, and age, significantly impact both the development and management of diabetes. Factors such as income, education, healthcare access, food security, and environment contribute to disparities in diabetes prevalence and outcomes. To effectively address diabetes from a public health perspective, it is essential to consider these systemic influences rather than focusing solely on individual behaviors.

Economic Status and Healthcare

One of the most significant determinants of diabetes outcomes is socioeconomic status. Income levels affect access to preventive healthcare, diabetes education, and essential treatments such as insulin and glucose monitoring devices. Individuals in low-income households often experience delayed diagnoses and have higher rates of diabetes-related complications due to inconsistent and later access to medical care. The high cost of diabetes treatments, including insulin, forces some individuals to ration their doses, increasing the risk of severe complications such as diabetic ketoacidosis, neuropathy, and organ failure. Uninsured individuals may struggle to afford continuous glucose monitors (CGMs) and insulin pumps, which improve diabetes management. Furthermore, a lack of access to regular check-ups with endocrinologists and diabetes educators puts disadvantaged populations at a greater risk of developing long-term complications. Addressing economic barriers could significantly improve diabetes outcomes for

many.

Food Security and Nutrition

Access to nutritious food is also critical in both preventing type 2 diabetes and managing all forms of diabetes. However, many people live in food deserts, where fresh produce and healthy options are scarce or unaffordable. Instead, these communities rely on processed,

calorie-dense, high-carbohydrate foods, which contribute to obesity and insulin resistance. Food insecurity forces individuals to prioritize quantity over quality, opting for cheaper, shelf-stable foods that often lead to poor glycemic control. Addressing this issue requires policy interventions such as subsidizing healthy food options, expanding food benefits, and investing in community-based food programs that improve access to diabetes-friendly diets.

Education and Health Literacy

Health literacy is important in diabetes prevention and self-management. Individuals with lower education levels often lack an understanding of essential diabetes concepts, such as carbohydrate counting, insulin use, and the importance of blood sugar monitoring.

Misinformation about diabetes, including myths like “eating too much sugar causes diabetes” contributes to stigma and inadequate self-care practices. Diabetes education programs have been shown to improve self-management, reduce hospitalizations, and enhance quality of life. Community health initiatives that provide culturally relevant, accessible diabetes education can help bridge the gap in health literacy and empower individuals to take control of their condition.

Environment

The built environment and neighborhood conditions significantly influence diabetes risk and management. Safe neighborhoods with accessible parks, sidewalks, and recreational spaces encourage physical activity, which helps regulate blood sugar levels and improve insulin sensitivity. However, in many low-income communities, unsafe streets, lack of green spaces, and limited recreational facilities discourage exercise, increasing the risk of obesity and type 2 diabetes. Environmental factors such as air pollution, chronic stress, and exposure to endocrine-disrupting chemicals have also been linked to diabetes prevalence. Addressing these issues requires urban planning strategies that promote walkability, access to recreational spaces, and pollution reduction policies.

Addressing SDoH

Diabetes is not just a medical condition, it is a societal issue influenced by systemic inequalities. While medical advancements such as improved insulin delivery systems and artificial pancreas technologies are promising, they are inaccessible to many due to economic and structural barriers. To reduce diabetes-related disparities, policymakers and healthcare systems must adopt a multi-sectoral approach that tackles the root causes of these social determinants. Economic disparities, food insecurity, limited health literacy, and environmental factors all play a role in who develops diabetes and how well they can manage it. By addressing these underlying issues through policy changes, community initiatives, and healthcare system improvements, we can create a future where diabetes is more preventable, manageable, and equitably treated. A holistic approach that considers both medical and social factors is essential for tackling the diabetes epidemic effectively.