Scientific Statement: Socioecological Determinants of Prediabetes and Type 2 Diabetes

In this article, we examine the socioecological determinants--the biological, geographic, and built environment factors--that influence risk for prediabetes type 2 diabetes. A socioecological perspective looks beyond the individual to evaluate a multitude of influences, from the surrounding home, work, school, and community environments to social determinants and the influence of public policy on individual behavior (1). Figure 1, adapted from the Institute of Medicine socioecological model of childhood obesity, provides a good framework for understanding potential socioecological determinants of risk for type 2 diabetes. In November 2012, the American Diabetes Association Prevention Committee convened a writing group to review the evidence on socioecological factors contributing to recent increases in prediabetes and type 2 diabetes. Drawing from the work of the committee, in this article we review the overarching evidence-based contributions of socioecological factors to risk for type 2 diabetes. Rather than incorporate the entire universe of relational observations, this scientific statement is intended to evaluate the extent to which data indicate a contributing role of social and environmental factors to the current epidemic of type 2 diabetes.