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

Background: Inequities in the clinical care and health outcomes of youth and young adults (YYA) 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 United States. Summary: This article offers a broad overview and analysis of disparities in clinical care and outcomes among youth and young adults (YYA) with type 1 and type 2 diabetes, 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 health care disparities by adopting an ethical approach that centers upon lived experiences of YYA with diabetes thereby identifying opportunities for more equitable care.