Anderson JB, Marstiller H, Shah K. Lean thinking for primary care. Prim Care. 2019; 46:(4)515-527

Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA. Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res. 2020; 13:(1)

Attridge M, Creamer J, Ramsden M, Cannings-John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2014; 4:(9)

Bain S, Rickford A, Black N Delivering joined-up care for people with type 2 diabetes: rationale, challenges and examples. British Journal of Diabetes. 2021; 21:(1)89-95

Barlow P, Mohan G, Nolan A, Lyons S. Area-level deprivation and geographic factors influencing utilisation of general practitioner services. SSM Popul Health. 2021; 15

Bhurji N, Javer J, Gasevic D, Khan NA. Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies. BMJ Open. 2016; 6:(4)

Burt J, Lloyd C, Campbell J, Roland M, Abel G. Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey. Br J Gen Pract. 2016; 66:(642)e47-52

Diabetes UK. Diabetes is serious. 2023a. https// (accessed 11 December 2023)

Diabetes UK. Prediabetes. 2023b. https// (accessed 11 December 2023)

EuroHealthNet. Mission and vision. 2023. https// (accessed 11 December 2023)

Goff LM. Ethnicity and Type 2 diabetes in the UK. Diabet Med. 2019; 36:(8)927-938

Goff LM, Moore A, Harding S, Rivas C. Providing culturally sensitive diabetes self-management education and support for black African and Caribbean communities: a qualitative exploration of the challenges experienced by healthcare practitioners in inner London. BMJ Open Diabetes Res Care. 2020; 8:(2)

Herrera D, Sanz M, Shapira L Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). J Clin Periodontol. 2023; 50:(6)819-841

Hu FB, Satija A, Manson JE. Curbing the Diabetes Pandemic. JAMA. 2015; 313:(23)2319-2320

Hurst JE, Barn R, Gibson L Geospatial mapping and data linkage uncovers variability in outcomes of foot disease according to multiple deprivation: a population cohort study of people with diabetes. Diabetologia. 2020; 63:(3)659-667

International Diabetes Federation. IDF diabetes atlas 2021. 2022. https// (accessed 11 December 2023)

Jupiter DC, Thorud JC, Buckley CJ, Shibuya N. The impact of foot ulceration and amputation on mortality in diabetic patients. I: From ulceration to death, a systematic review. Int Wound J. 2016; 13:(5)892-903

Kwok CS, Satchithananda D, Ahmed FZ A critical evaluation of patient pathways and missed opportunities in treatment for heart failure. J Cardiovasc Dev Dis. 2022; 9:(12)

Lamster IB. The 2021 WHO resolution on oral health. Int Dent J. 2021; 71:(4)279-280

Manu C, Lacopi E, Bouillet B Delayed referral of patients with diabetic foot ulcers across Europe: patterns between primary care and specialised units. J Wound Care. 2018; 27:(3)186-192

Mathur R, Palla L, Farmer RE, Chaturvedi N, Smeeth L. Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: a cohort study in the UK Clinical Practice Research Datalink. Diabetes Res Clin Pract. 2020; 160

McGrail K, Morgan J, Siddiqi A. Looking back and moving forward: Addressing health inequities after COVID-19. Lancet Reg Health Am. 2022; 9

McKeigue PM, McGurnaghan S, Blackbourn L Relation of incident type 1 diabetes to recent COVID-19 infection: cohort study using e-health record linkage in Scotland. Diabetes Care. 2023; 46:(5)921-928

McQueenie R, Ellis D, McConnachie A, Wilson P, Williamson A. Morbidity, mortality and missed appointments in healthcare: a national retrospective data linkage study. BMC Med. 2019; 11;17:(1)

Messaaoui A, Hajselova L, Tenoutasse S. Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium. J Pediatr Endocrinol Metab. 2021; 34:(10)1319-1322

Mishra V, Seyedzenouzi G, Almohtadi A Health inequalities during COVID-19 and their effects on morbidity and mortality. J Healthc Leadersh. 2021; 13:19-26

Nagar SD, Nápoles AM, Jordan IK, Mariño-Ramírez L. Socioeconomic deprivation and genetic ancestry interact to modify type 2 diabetes ethnic disparities in the United Kingdom. EClinicalMedicine. 2021; 37

Using economic development to improve health and reduce inequalities. 2020. https// (accessed 11 December 2023)

National Voices. Principles for integrated care. 2013. https// (accessed 11 December 2023)

National Institute for Health and Care Excellence. Community engagement: improving health and wellbeing and reducing health inequalities. NICE guideline NG44. 2016. https// (accessed 11 December 2023)

National Institute for Health and Care Excellence Diabetic foot problems: prevention and management. NICE guideline NG19. 2019. https// (accessed 11 December 2023)

NHS Digital. Young people with type 2 diabetes, 2019-20. National Diabetes Audit. 2021. http// (accessed 11 December 2023)

NHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. 2021. http// (accessed 11 December 2023)

Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020; 41:513-535

Ocloo J, Garfield S, Franklin BD, Dawson S. Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews. Health Res Policy Syst. 2021; 19:(1)

How to maximise the impact of diabetes consultations: a guide for healthcare professionals. 2020. https// (accessed 11 December 2023)

Office for National Statistics. Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England and Wales: deaths occurring 2 March to 28 July 2020. 2020. https// (accessed 11 December 2023)

Office for Health Improvements and Disparities. Diabetes Footcare 2018-2021. 2023a. https// (accessed 11 December 2023)

Office for Health Improvement and Disparities. Excess mortality in England and English Regions. 2023b. https// (accessed 11 December 2023)

Phillips A. Recognising the importance of self-management for people with diabetes. British Journal of Healthcare Management. 2019; 25:(7)224-229

Phillips A. Diabetes care: a time to review prescribing approaches and reach out to local communities. Journal of Prescribing Practice. 2021; 3:(5)176-182

Phillips A. Community-focused diabetes care to tackle health inequalities. British Journal of Healthcare Management. 2023; 29:(7)173-176

How to make the most of your consultations in diabetes care with people living with diabetes. 2020. https// (accessed 11 December 2023)

Poupakis S, Kolotourou M, MacMillan HJ, Chadwick PM. Attendance, weight loss, and participation in a behavioural diabetes prevention programme. Int J Behav Med. 2023;

Public Health England. Health inequalities: reducing ethnic inequalities. Guidance to support local and national action on ethnic inequalities in health. 2018. https// (accessed 11 December 2023)

Razai MS, Kankam HKN, Majeed A, Esmail A, Williams DR. Mitigating ethnic disparities in Covid-19 and beyond. BMJ. 2021; 372

Why are some patients failing to engage with foot services earlier (not attending appointments or not attending in a timely manner, don't comply with diabetic advice, don't do regular foot checks) and have frequent hospital admissions and/or amputations?. 2022. https// (accessed 11 December 2023)

Royal College of Paediatrics and Child Health. National Paediatric Diabetes Audit (NPDA) annual report on care processes and outcomes 2021/22. 2023. https// (accessed 11 December 2023)

Salmi H, Heinonen S, Hästbacka J New-onset type 1 diabetes in Finnish children during the COVID-19 pandemic. Arch Dis Child. 2022; 107:(2)180-185

Salvatore T, Galiero R, Caturano A Current knowledge on the pathophysiology of lean/normal-weight type 2 diabetes. Int J Mol Sci. 2023; 24:(1)

Seewoodhary J. Black lives matter: tackling racial and ethnic inequalities in diabetes health care. Pract Diabetes. 2021; 38:(3)26-30

Mass media to communicate public health messages in six health topic areas: a systematic review and other reviews of the evidence. 2019. https// (accessed 11 December 2023)

Stewart M. Towards a global definition of patient centred care. BMJ. 2001; 322:(7284)444-445

Thomas NJ, Walkey HC, Kaur A The relationship between islet autoantibody status and the genetic risk of type 1 diabetes in adult-onset type 1 diabetes. Diabetologia. 2023; 66:(2)310-320

Understanding integration: how to listen to and learn from people and communities. 2021. https// (accessed 11 December 2023)

Whicher CA, O'Neill S, Holt RIG. Diabetes in the UK: 2019. Diabet Med. 2020; 37:(2)242-247

Williams DR. Miles to go before we sleep: racial inequities in health. J Health Soc Behav. 2012; 53:(3)279-295

Wilson C, Alam R, Latif S, Knighting K, Williamson S, Beaver K. Patient access to healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a systematic review. Health Soc Care Community. 2012; 20:(1)1-19

World Health Organization. Social determinates of health: key concepts. 2013. https// (accessed 11 December 2023)

World Health Organization. Keeping the 100-year-old promise: making insulin access universal. 2021. https// (accessed 11 December 2023)

World Health Organization. Childhood obesity: five facts about the WHO European Region. 2023. https// (accessed 11 December 2023)

Wong BLH, Maaß L, Vodden A The dawn of digital public health in Europe: Implications for public health policy and practice. Lancet Reg Health Eur. 2022; 14

Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2022; 10:(5)311-321

Xu H, Jin C, Guan Q. Causal effects of overall and abdominal obesity on insulin resistance and the risk of type 2 diabetes mellitus: A two-sample mendelian randomization study. Front Genet. 2020; 11

Zeh P, Sandhu HK, Cannaby AM, Sturt JA. The impact of culturally competent diabetes care interventions for improving diabetes-related outcomes in ethnic minority groups: a systematic review. Diabet Med. 2012; 29:(10)1237-1252

Call to action on diabetes care: reaching communities facing health inequalities, health inequities and deprivation

11 January 2024
Volume 33 · Issue 1


This article presents evidence and policy on the importance of reaching out into local communities with inclusive approaches to try to reduce and prevent inequities and inequalities in diabetes care. The global emergency diabetes is causing and the risks and disproportionately high ethnic disparities are investigated. The article includes some suggestions on changing approaches to reduce health inequalities to enable diabetes care to become more accessible for those who need it the most.

The International Diabetes Federation (IDF) (2021) has announced that diabetes is ‘a significant global challenge to the health and wellbeing of individuals, families and countries’. The prediction of a 46% rise in the number of people with diabetes worldwide, which equates to 783 million people being diagnosed by 2045, is alarming. This is coupled with a widening gap between rich and poor communities in countries and continents where access to health care can be limited and expensive. South East Asia is facing a 69% rise, Europe a 13% rise and across Africa a 134% rise to 2045 (IDF, 2021), which consequently places great pressure on existing services and further widens gaps in limited diabetes care throughout many continents.

In the UK, more than 5 million people are living with diabetes (Diabetes UK, 2023a). This figure, however, does not include the 13.6 million people thought to be at risk of diabetes (Diabetes UK, 2023b). However around 50% of those could prevent their condition developing through the current diabetes prevention programmes available (Poupakis et al, 2023). The World Health Organization (WHO) (2023) has ranked the UK among the those countries in Europe with high numbers of overweight and obese adults, and 1 in 3 children in the European region are reported to be overweight or obese. It is worrying that NHS Digital (2021) has reported an increased incidence in type 2 diabetes in people under 40.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content