. Author manuscript; available in PMC: 2024 May 6.

Published in final edited form as: Lancet Diabetes Endocrinol. 2023 Jun 22;11(7):509–524. doi: 10.1016/S2213-8587(23)00129-8

Table: Contributors (ie, levels of influence and domains of influence over the life course) to diabetes using Agarwal and colleagues’ framework14.

	Individual	Interpersonal	Community	Societal
Health behaviours and social norms	Health behaviours and coping strategies: smoking and sedentary lifestyle; sociodemographic; cultural identity; response to discrimination; cultural beliefs;^* stigma;^* acculturation; body image perceptions;^* poor English proficiency;^* and comorbid health conditions:⁷⁴ depression,^⁷⁵ hypertension,^ heart disease,^* and autoimmune conditions^*	Family functioning: parental modelling;^† and caregiver–child interaction: gestational diabetes,^†^76–78 intrauterine exposure to diabetes,^†^21,79 and preterm birth^†^80,81	Community functioning: food eating practices of a community (eg, type of food and communal eating),^82,83 acculturation,⁸⁴ fear of Western medical practices, scarcity of preventive health seeking behaviour,⁸⁵ social dietary temptations and overcoming temptations,⁸⁴ apathy (ie, the inevitability of diabetes in the community),^86,87 and weight perception⁸⁸	Policies and laws: reducing stress exposure via policy,⁸⁹ association between food prices and insulin resistance,⁹⁰ mandating diabetes education through policy,⁹¹ social norms, societal structural discrimination, smoking as a norm in American Indian and other Native American communities,^†⁹² machismo (ie, masculine ideologies) as driver of health neglect in Mexican men,^⁹³ cultural traditions as a challenge to immigrants managing chronic illness,^⁹⁴ effect of colonisation on diabetes risk factors in Indigenous communities,⁹⁵ and education discrimination^*⁹⁶
Economic development	Personal environment:⁹⁷ income, employment status and job stability, and education level	Household environment: household food insecurity,⁹⁸ homelessness,^⁹⁹ housing instability,^¹⁰⁰ and energy insecurity;^*¹⁰¹ school or work environment; and stress at work¹⁰²	Community environment,⁹⁸ neighbourhood walkability,^*¹⁰³ exposure to greenspace,^†¹⁰⁴ community resources, poor access to affordable diabetes-friendly food compared with relatively easy access to unhealthy food,^105–107 and area deprivation index (housing, income, employment, education)¹⁰⁸	Societal structure: neighbourhood discrimination,^106,109 neighbourhood disadvantage contributes to disproportionate diabetes burden,^110–112 and food insecurity^113–115
Public awareness	Diabetes knowledge and distress,¹¹⁶ diabetes-related knowledge,^* and diabetes self-management knowledge^*	Social networks, parental and familial modelling,^†¹¹⁷ social support;¹¹⁸ family and peer norms and traditional gender roles:^†¹¹⁸ familial social interactions;^†¹¹⁸ and social norms^*^119,120	Community norms; local structural discrimination; diabetes-related social stigma;^*^121,122 and young adults: community expectations of self-independence, employment, and care of siblings¹²³	..
Access to high-quality care	Insurance coverage, health literacy, and treatment preferences; regional variation;^¹²⁴ health literacy and numeracy;^^125,126 fear of medications and insulin medication adherence;^¹²⁷ and cost^¹²⁸	Patient–clinician relationship: perceived discrimination,¹²⁹ communication,^^130–133 lack of trust,^^132,134,135 physicians’ empathy,^¹³⁶ medical decision-making, not enough shared decision-making,^^132,137 non-adherence labelling,^*^138,139 discriminatory health-care practices,^140,141 and variations in phenotypes not targeted^†^70,142	Health-care access, subspecialty care (endocrinologist),^¹⁴³ safetynet clinics and hospitals,^ mental health services,^* diabetes self-management education,^¹⁴⁴ and transition services for young adults from the paediatrician to adult provider^¹²³	Health-care affordability and quality, differential access to technology for diabetes management (including telehealth and continous glucose monitoring),¹⁴⁵ differential access to new anti-diabetic medication,¹⁴⁶ and differential access to subspecialty care¹⁴⁷
Structural racism	Sociodemographic, cultural identity, response to discrimination, stigma,^* acculturation, poor English proficiency,^* chronic stress,¹⁴⁸ poor sleep, and obesity¹⁴⁹	Interpersonal discrimination, major experiences of discrimination,^†^150,151 perceived everyday racism,^†¹⁵² lifetime racism,^†¹⁵² racial discrimination,^^153–155 and microaggressions^¹⁵⁶	Community environment,⁹⁸ neighbourhood walkability,^¹⁰³ exposure to greenspace,^†¹⁰⁴ community resources, restricted access to affordable diabetes-friendly food compared with relatively easy access to unhealthy food,^105–107 area deprivation index (housing, income, employment, education),¹⁰⁸ and environmental exposures: air pollution,^†¹⁵⁷ heat exposure,^¹⁵⁸ and endocrine-disrupting chemicals^†¹⁵⁹	Societal structure: neighbourhood discrimination,^106,109 neighbourhood disadvantage contributes to disproportionate diabetes burden,^110–112 and food insecurity;^113–115 and exposure: climate-induced extreme weather events (heat, cold, natural disasters);¹⁶⁰ and sanitation

Disparities in diabetes management and control only.

^†

Disparities in diabetes incidence only.