715-P: Multilevel Health Care System Factors Influencing Type 2 Diabetes Disparities in the United States—An Integrative Review

Introduction: In the United States, minority populations are disproportionately impacted by and experience worsened outcomes from type 2 diabetes (T2D). The National Institute of Minority Health and Health Disparities (NIMHD) Research Framework guided this study to synthesize the scientific evidence identifying health care system factors influencing T2D health disparities among minority populations in the US.

Methods: A literature search was conducted on PubMed, CINAHL, PsycINFO, and Scopus for articles published between 2017 and 2023 with outcomes of glucose homeostasis and T2D disparities in minority populations (as defined by NIMHD). Two reviewers independently extracted data for descriptive and narrative analysis.

Results: Among the 108 included studies, 33 (30.5%) reported associations between measures of glucose homeostasis and multilevel factors in the health care system. Within this domain, most studies were conducted at the community (30.3%) and individual (21%) levels, with only 15% including multiple levels. The overarching factors influencing T2D disparities included: 1) Treatment preferences, 2) Multidisciplinary approaches, 3) Technology enhanced education and support, 4) Language translation services, 5) Integrated clinical and community care approaches, 6) Access to services in rural areas, 7) Insurance access/coverage/stability, and 8) Racism and discrimination.

Conclusions: Studies included in this review highlight the complex interplay between the levels of influence in the NIMHD framework, the health care system, and the subsequent outcome of T2D disparities. More studies are needed across multiple levels of influence in the health care system to better understand drivers of these inequities and inform T2D health disparities research and practice.