A Narrative Review on the Risk Factors and Healthcare Disparities of Type 2 Diabetes

Abstract

Type 2 diabetes (T2D) is a rapidly growing global health concern, projected to affect 1.3 billion people by 2050, necessitating a multidisciplinary approach. This review examines the epidemiological disparities in T2D, focusing on modifiable and nonmodifiable risk factors, socioeconomic determinants, and healthcare inequities. While genetic predisposition, age, and ethnicity contribute to T2D risk, socioeconomic status (SES) significantly mediates modifiable factors such as diet, physical activity, and access to healthcare. Lower SES is associated with poorer lifestyle choices, limited access to resources, and increased exposure to risk factors, exacerbating T2D prevalence among vulnerable populations. Geographic variations in T2D prevalence are evident, with racial and ethnic minorities and lower-income individuals being disproportionately affected in regions like the United States and Europe. The economic burden of T2D is substantial, with global healthcare expenditures reaching USD 966 billion in 2021 and projected to rise significantly, albeit with variations across different countries and health systems. Despite advancements in treatment, inequities in healthcare access persist, particularly in low- and middle-income countries, hindering optimal glycemic control and consequently contributing to preventable complications and poor health outcomes. This review highlights the critical need for targeted interventions and policy reforms to address the intersection of demographic, economic, and healthcare-related variables influencing T2D disparities. By bridging gaps in prevention, management, and treatment and accounting for the effect of SES on both modifiable and nonmodifiable risk factors, the global disease burden of T2D could be reduced and health equity could be improved.

1. Introduction

Type 2 diabetes (T2D) has been positioned among the highest public health and scientific priorities, given the rapid rise in cases and the projected surge from 500 million to 1.3 billion by 2050. Consequently, the management of T2D warrants a prompt and thorough multidisciplinary approach [1,2,3].

Diabetes is a chronic metabolic disorder characterized by impaired insulin secretion and/or action, resulting in persistent hyperglycemia. Sustained elevations in blood glucose can lead to both acute complications, such as diabetic ketoacidosis, and long-term complications, including retinopathy, chronic kidney disease, and diabetic foot ulcers, all of which substantially diminish quality of life and reduce life expectancy [4]. Achieving optimal glycemic control, typically defined as a hemoglobin A1c (HbA1c) level of around 53 mmol/mol (7%), is crucial in mitigating the risk and progression of macrovascular complications, such as coronary artery disease and stroke, as well as microvascular complications, including nephropathy and retinopathy [5,6,7,8,9].

The distribution of T2D varies considerably across geographic regions, socioeconomic backgrounds, and demographic groups [10]. Racial and ethnic minorities, individuals with lower incomes, and those facing barriers to healthcare access often experience a higher prevalence of the disease and worse health outcomes [10]. In the United States (US), T2D disproportionately affects certain racial and ethnic groups, while in Europe, populations of South Asian, African-Caribbean, and Middle Eastern descent face an elevated risk [11,12]. Socioeconomic factors play a critical role in shaping disease patterns, as limited financial resources are associated with restricted healthcare access, suboptimal nutrition, and fewer opportunities for physical activity, all of which contribute to the increased burden of T2D [13,14].

Beyond its clinical impact, T2D imposes a staggering economic and societal burden. In 2021, global healthcare expenditures related to diabetes reached USD 966 billion, with projections exceeding USD 1.054 trillion by 2045 [2]. In the US, diabetic peripheral neuropathy alone accounts for an estimated USD 10.9 billion annually, while in the United Kingdom (UK), diabetic ulceration and amputation place a financial strain of up to GBP 962 million per year on the National Health Service (NHS) [15,16]. By 2030, the global economic cost of diabetes and its complications is expected to rise to USD 2.1 trillion—a 61% increase from 2015—even if countries succeed in reducing diabetes-related mortality by one-third, as outlined in the Sustainable Development Goals [17].

Despite advancements in pharmacological and nonpharmacological interventions, barriers to equitable healthcare access persist, contributing to disparities in diabetes-related morbidity and mortality. While newer insulin formulations and glucose-lowering therapies have demonstrated cost-effectiveness in reducing complications, their accessibility remains uneven, particularly in low- and middle-income countries. Therapy, diagnostics, and monitoring access, in particular, is hindered by high costs, inadequate healthcare infrastructure, and disparities in insurance coverage, leading to preventable complications and premature deaths [18,19,20,21].

Aims and Objectives

This narrative review aims to provide a comprehensive analysis of the epidemiological disparities in T2D, examining modifiable and nonmodifiable risk factors, socioeconomic determinants, and inequities in healthcare access. By searching for the most up-to-date and relevant literature and by highlighting the intersection of demographic, economic, and healthcare-related variables, this review underscores the need for targeted interventions and policy reforms to bridge existing gaps in diabetes prevention, management, and treatment outcomes. Addressing these disparities is critical to reducing the global burden of T2D and improving health equity worldwide.

2. Modifiable Risk Factors of T2D

T2D has been associated with several modifiable risk factors, which are lifestyle-related factors that can be changed to reduce the risk of developing the disease. A healthy diet, rich in vegetables and whole grains, can prevent the onset of T2D, whereas a diet consisting of fats and sugar can put one at risk for developing the disease [13,22]. Physical activity, in addition to a healthy diet, is a key modifiable factor for T2D, as regular physical activity helps lower insulin resistance and can prevent or delay the onset of the disease according to the American Health Association [23,24]. If a healthy diet and a regular exercise regimen are not followed, there is a higher risk of being overweight or obese, which consequently increases the risk for T2D [22,23]. Moreover, smoking and excessive alcohol consumption are linked with T2D, the latter contributing to high blood sugar levels [23,25]. Lack of sleep is also associated with T2D as it disrupts glucose metabolism by reducing insulin sensitivity, meaning that the body’s cells become less responsive to insulin, leading to higher blood sugar levels. Moreover, sleep deprivation increases the production of stress hormones like cortisol. Elevated cortisol levels can raise blood sugar levels and contribute to insulin resistance, further increasing the risk of developing T2D.

Lower socioeconomic status (SES) increases the risk for developing T2D, as it can limit one’s access to healthcare and healthy choices. Indeed, SES is a key factor for T2D, as it affects almost all the other modifiable risk factors. Firstly, lower SES is significantly associated with poor sleep quality and continuity. Individuals from lower SES backgrounds often experience more sleep disturbances due to several factors, including stress over financial instability and irregular work schedules, environmental factors, such as crowded living conditions, and lack of awareness about the importance of sleep [26,27,28]. Similarly, smoking and excessive alcohol consumption are more prevalent in populations with lower SES, either as a result of lower education about their consequences or because these habits are often used as coping mechanisms for stress [29]. Furthermore, healthier foods tend to be more expensive than less healthy, energy-dense options. Individuals with a lower SES may be unable to afford healthier food options, considering the higher chances of food insecurity these households face [14]. In the context of financial instability, recession, and uncertainty, almost all aspects of household food provisioning are negatively affected, leading to choices that increase the risk for T2D [30]. Lastly, lower SES communities often have limited access to safe and well-maintained parks, recreational facilities, and other environments conducive to physical activity [31]. What is more, engaging in organized physical activities or sports often requires financial resources for equipment, membership fees, or transportation, which can be a barrier for lower SES individuals, while they may also have less leisure time due to work demands and family responsibilities [32].

Thus, the modifiable risk factors for diabetes are only modifiable to the extent allowed by one’s SES; education programs around the importance of smoking cessation and moderate alcohol consumption, which are not affected by one’s SES, could significantly improve the status of multiple individuals [33].

3. Nonmodifiable Risk Factors of T2D

Nonmodifiable risk factors include those that cannot be changed by the person being at risk for developing the disease. Genetic factors play a significant role in the development of T2D, with multiple genetic studies having shown a clear hereditary component to both T2D and its associated complications [34]. A meta-analysis of 34,166 same-sex twin pairs across eight international cohorts found 72% heritability for T2D [34]. When a parent or sibling has T2D, there is a higher risk for a person to develop the disease as well. Notably, the risk can be higher if both parents have T2D [23,35]. That said, in a longitudinal Finnish study, physical activity reduced T2D risk in genetically predisposed twins, emphasizing the gene–lifestyle interplay [34]. Insulin gene mutations, disruption of insulin biosynthesis, and impaired insulin signaling are some of the ways in which genetic changes can impact insulin production and glucose regulation [36]. Family history, while nonmodifiable, can help to identify individuals at a higher risk. However, lack of awareness and education, linked with lower SES, can hinder this.

The risk of developing T2D increases with age, particularly after the age of 35 [37]. Most people being diagnosed with T2D are already middle aged, with an estimated 14% and 25% of Americans aged 45–64 and 65 and older having the condition [38]. Notably, being overweight has been linked with older age, with the prevalence of overweightness and obesity often peaking in middle age. For instance, in the US, the prevalence of obesity is higher in people aged between 40 and 49 years compared to younger adults [39]. Moreover, lifestyle changes that occur with aging, such as reduced physical activity, contribute to the increased prevalence of overweight and obesity in older age groups, which consequently increase the risk for T2D further.

A person’s ethnic group is an additional recognized risk factor for T2D. In the US, American Indians and Pacific Islanders have the highest rates of T2D, followed by African Americans, Hispanic people, and Asian Americans, who are also at higher risk compared to non-Hispanic white people [40,41]. One of the ways in which ethnicity interacts with the risk for T2D is body composition. Different racial groups may have varying body compositions and fat distributions, which can affect insulin sensitivity. For example, South Asian people tend to have more visceral fat, increasing their risk for insulin resistance and T2D [42]. While genetic differences among racial and ethnic groups may contribute to some extent, they are not the primary cause of these disparities. On the contrary, environmental and lifestyle factors, such as diet and socioeconomic status, play a more significant role [43]. Ethnicity often influences SES, as racial and ethnic minorities are more likely to experience socioeconomic disadvantages. Communities segregated by SES and ethnic group often have low economic development, poor health conditions, and low levels of educational attainment [44]. Consequently, ethnic minorities, often having low SES, face a higher risk for developing T2D due to lack of education, access to healthy food and exercise, and a quality sleep schedule.

Lastly, women who have had gestational diabetes during pregnancy are at increased risk of developing T2D later in life [23,45]. This risk can be alleviated if the person at risk follows a healthy diet, combined with regular exercise, whilst avoiding other lifestyle factors that adversely influence insulin resistance, such as smoking and alcohol consumption. However, a woman with a lower SES could not be aware that she is at a higher risk for developing T2D or, in the case she is aware, financial constraints could hinder her from adopting a healthy diet and regular exercise regimen, thus further increasing the risk for developing T2D.

4. Epidemiology of T2D by Age, Ethnic Group, Gender, and Socioeconomic Status

T2D is a major global health concern, with its prevalence expected to rise significantly over the coming decades. In 2022, an estimated 828 million adults globally had diabetes, an increase from 630 million in 1990 [10]. Notably, T2D prevalence is estimated to increase to 1.3 billion by 2050; however, thanks to improving therapy options, people with T2D live longer today than in previous decades, which could account for the increasing prevalence to some degree [46,47].

T2D is a significant health concern in North America. In the US, the prevalence varies across different demographic categories. T2D prevalence is highest among older adults, with disease prevalence in 2016 being significantly higher among adults aged ≥65 years compared to those aged 18–29 years [48]. The incidence of T2D has also increased significantly across all age groups, particularly among children and adolescents [11]. The estimated incidence of diagnosed young-adult-onset T2D was 3.0 per 1000 adults between 2016 and 2022, with minority groups, socioeconomically disadvantaged individuals, and people with cardiometabolic diseases or psychological conditions having a higher incidence [49]. It is worth highlighting that individuals developing T2D in 2025 are generally younger than those diagnosed 40 years ago, particularly due to the changes in lifestyle, the higher rates of obesity amongst children, and the higher rates of prediabetes [50,51,52,53].

In the US, the highest T2D prevalence in 2021 was recorded among non-Hispanic Black people (12.1%), followed by Hispanic people (11.7%), non-Hispanic Asian people (9.1%), and non-Hispanic white people (6.9%) [11]. These data are consistent with a cross-sectional study conducted between 2011 and 2016 in the US [41]. Adults with less than a high school education had a higher prevalence of diagnosed diabetes at 13.1% in 2021, those with a high school education had a prevalence of 9.1%, and those with more than a high school education had the lowest prevalence at 6.9% [11]. It is important to note that a lower education level is directly linked to a low SES level while, as aforementioned, ethnic minorities are more likely to experience socioeconomic disadvantages, which in turn increase one’s risk for T2D. Conversely, a higher SES is associated with a lower risk for T2D, with individuals with a family income above 500% of the federal poverty level having the lowest prevalence of diagnosed diabetes [11]. In Canada in 2024, approximately 4 million people (10% of the population) were living with diagnosed diabetes, with T2D accounting for approximately 90% of all cases [54,55]. While there are no nationwide data for the increase in T2D prevalence in the last decades, a study in New Brunswick found a 120% increase in the prevalence of T2D between 2001 and 2014 [56]. The prevalence of diabetes is projected to increase by 32% in Canada by 2034 [55].

Similarly to the US, T2D is a significant health concern in Europe as well, with prevalence varying across different demographic categories. As of 2021, approximately 61 million adults in Europe were living with diabetes, with an age-adjusted comparative prevalence of about 7% [57]. By 2045, the number of people with diabetes in Europe is projected to increase to about 69 million, with 1 in 10 Europeans potentially living with diabetes [57]. Prevalence rates vary significantly across European countries. For instance, the Netherlands (11,344 cases per 100,000) and Sweden (10,448 cases per 100,000) have higher prevalence rates compared to countries like Turkey (6483 cases per 100,000) and Russia (6865 cases per 100,000) [58]. Regarding ethnic groups, a meta-analysis about T2D in migrants in Europe showed that South Asian people had nearly four times the risk for T2D compared to Europeans, while people of African-Caribbean descent and Middle Eastern and North African populations are also associated with a higher prevalence compared to Europeans [12,59]. Approximately one-third of people living with diabetes in Europe remain undiagnosed, with significant variations across countries [60]. Lastly, up to half of those diagnosed with diabetes may not meet their treatment targets, highlighting the need for improved healthcare systems and access to diabetes care [60].

In Australia, T2D is a public health concern, although with a lower prevalence compared to North America and Europe. In 2021, approximately 1.2 million people (4.6% of the population) were living with T2D [61]. The number of Australians living with T2D more than tripled between 2001 and 2021, while each year approximately 45,700 people are newly diagnosed [60]. Interestingly, in 2018–2019, approximately 10.7% (51,900) of Aboriginal and Torres Strait Islander people were living with T2D [61]. The prevalence of T2D is growing by 2.9% annually, with recent projections indicating that the number of people in Australia living with diabetes will reach 3.6 million by 2050 [62], referring only to diagnosed diabetes.

5. Cost of T2D and Health Inequities

The global cost of diabetes is projected to almost double to USD 2.5 trillion by 2030 according to research by King’s College London [63]. Other than the direct economic costs, T2D is also associated with significant social consequences, including lower productivity, employment barriers, and decreased education attainment potential [64].

In 2022, the total cost of diagnosed diabetes in the US was an estimated USD 412.9 billion, of which USD 306.6 billion was due to direct medical costs and USD 106.3 billion was due to indirect costs [65,66]. That said, according to a systematic literature review of economic evaluations of insulin for the management of T2D, it was found that degludec/DegLira and semaglutide are very effective in managing symptoms, thus being cost-effective despite their high cost [67]. In the US, out-of-pocket (OOP) costs for T2D vary depending on factors such as income and Medicare status [68]. A 2023 study updated previous estimates on the economic burden of diagnosed diabetes, calculating health resource use and indirect costs attributable to diabetes in 2022. Interestingly, individuals with lower SES had lower OOP costs but higher burden, contrary to individuals with higher SES [68]. In 2017, Medicare beneficiaries with diabetes spent an average of USD 928 OOP for prescription drugs [69]. Nearly 60% of Medicare beneficiaries with diabetes had OOP costs that exceeded 10% of their income and almost 30% had costs exceeding 20% of their income [68]. Upon reaching age 65, quarterly OOP costs for T2D drugs increased by USD 23.04 at the mean and USD 56.36 at the 95th percentile, even after adjusting for changes in utilization [69]. Notably, high OOP costs for T2D medications can hinder adherence to treatment guidelines and effective management of the condition [69], which consequently leads to days missed from work or education attainment. Indeed, studies suggest that in the US, full-time workers with diabetes miss an average of 5.5 extra workdays per year, while part-time workers miss an additional 4.3 days [70]. Finally, diabetes has also been linked with higher rates of unemployment; in 2020, 18% of people with diabetes were unemployed or furloughed compared to the national rate of 12% [71]. In Canada, a 2017 study estimated that the total healthcare costs attributable to diabetes over a 10-year period were USD 15.36 billion [72]. The OOP costs for individuals managing T2D can reach as high as USD 10,014 per year in certain regions [55], with these costs constituting a notable percentage of a family’s income, while for some households, these costs are “catastrophic” [73]. Employees with diabetes in Canada miss between 2 to 10 more workdays per year than employees without diabetes [74]. Reduced productivity and missed work due to T2D costs employers an estimated USD 1500 annually per employee [75]. In addition, when a low blood sugar event occurs at work, 18% of people leave work early or miss a full day, which equates to 9.9 h of work per month [75].

In 2021, the cost of T2D treatment across Europe was EUR 176 billion [76], with half of the total T2D-related healthcare costs in Europe being a consequence of hospitalizations for health emergencies that arise when the condition is not effectively managed [77]. Generally, many European countries offer more comprehensive healthcare coverage compared to the US, resulting in lower OOP expenses for individuals with T2D [78]. In countries such as the UK and Germany, the NHS and statutory health insurance, respectively, ensure that most diabetes management costs are covered, minimizing the financial burden on patients [78]. A comparison of costs across several European countries in the late 1990s is available but may not reflect current prices [79]. While direct costs are mostly covered by national insurance in most European countries, societal costs still exist and add to the disease burden associated with T2D. In 2020–2021, approximately AUD 2.3 billion within the Australian health system was attributed to T2D [80], with a significant portion of this cost being linked to hospitalizations, with 11% of all hospitalizations in Australia being a result of diabetes [81].

Healthcare disparities significantly affect outcomes for patients with T2D, with factors such as SES, ethnic group, and geographical location playing a critical role in this aspect. These disparities manifest in access to treatment, routine healthcare, and overall clinical outcomes [82]. Consequently, individuals with limited access to healthcare often experience delayed diagnosis and treatment, leading to poorer T2D management and higher HbA1c levels [83]. Notably, individuals with lower SES may be less engaged with healthcare and have higher rates of missed appointments [83], while according to a systematic literature review looking at health disparities in diabetes in the US, limited access to healthcare is more prevalent in individuals belonging in ethnic and/or racial minorities [84]. For example, Puerto Rican adults with diabetes may be less likely to receive annual HbA1c testing and other essential services compared to white individuals [84]. This means that the groups that are at a higher risk for T2D also face barriers when accessing care and, as a consequence, worse outcomes, thus affecting their employment and education. Finally, the groups that are at a higher risk for T2D also face significant costs in the case that they live in countries without national insurance schemes. Uninsured individuals with diabetes spend significantly less on diabetes medications compared to those with private insurance, impacting their ability to manage the condition effectively [85].

The authors acknowledge that differences in healthcare systems, treatment pricing, and economic contexts make direct cost comparisons complex, rendering this a limitation of this review. In the future, studies could use healthcare costs as a percentage of GDP (or BNP per capita), thus enhancing comparability. Moreover, very limited data on costs are available from the MENA region and from Southeast Asia, where T2D incidence has been increasing significantly. Hence, this gap in the literature warrants for health economics and outcomes research studies in these regions.

6. Influence of Comorbidities and Complications

T2D disproportionately affects marginalized populations, with epidemiological disparities in care significantly exacerbating complications and increasing morbidity and mortality [18,86]. Cardiovascular disease, the leading cause of death in T2D patients, is more prevalent and severe among racial/ethnic minorities and individuals of lower socioeconomic status due to inadequate access to preventative care, poor glycemic control, and delayed intervention. Structural inequities limit the prescription and affordability of cardioprotective agents such as SGLT2 inhibitors and GLP-1 receptor agonists despite their proven efficacy in reducing cardiovascular events and promoting weight loss [87]. Recent evidence highlights that GLP-1 RAs provide significant metabolic and quality-of-life benefits by improving glycemic control, reducing adiposity, and decreasing cardiovascular risk in T2D patients [88]. Similarly, chronic kidney disease progression is accelerated in underprivileged populations due to restricted access to nephrology specialists, renoprotective agents (e.g., SGLT2 inhibitors), suboptimal hypertension management, and late-stage diagnosis. This leads to disproportionately higher rates of end-stage renal disease and dialysis dependency in Black, Hispanic, and Indigenous populations compared to their white counterparts [89,90].

Obesity interacts with socioeconomic determinants of health, as food insecurity and limited physical activity resources contribute to excess adiposity. As a primary driver of insulin resistance, it is now increasingly managed with GLP-1/(GIP) RAs, which regulate satiety, reduce energy intake, and promote sustainable weight loss. For example, studies have shown that semaglutide treatment significantly improves patient-reported outcomes related to physical and mental health, particularly in individuals with T2D struggling with obesity. Despite these benefits, socioeconomic disparities restrict access to these medications, limiting their potential to improve diabetes management and the overall quality of life in disadvantaged groups [88].

Metabolic-dysfunction-associated steatotic liver disease disproportionately burdens these populations, leading to a higher incidence of hepatic fibrosis and hepatocellular carcinoma [91]. Furthermore, disparities in vision care access result in higher rates of severe diabetic retinopathy and blindness in racial minorities, particularly in regions lacking routine ophthalmologic screening [92].

Diabetic neuropathy, a major contributor to nontraumatic lower-limb amputations, illustrates one of the most striking disparities in diabetes care [93]. For instance, African American and Indigenous populations in the US experience amputation rates notably higher than white populations, largely due to delayed diagnosis, inadequate preventive foot care, and limited access to multidisciplinary wound care teams. This disparity reflects broader systemic barriers, including geographic maldistribution of specialized diabetes clinics and financial constraints that hinder adherence to advanced therapeutics [93].

Ultimately, inequities in healthcare access and quality exacerbate T2D complications, perpetuating cycles of disability, financial hardship, and premature mortality. Addressing these disparities necessitates targeted policy interventions, expanded insurance coverage for high-risk populations, increased investment in community-based preventive programs, and equitable distribution of emerging diabetes therapies. Without structural reforms, the gap in outcomes between privileged and disadvantaged groups will continue to widen, amplifying the global burden of T2D and its complications.

7. Global Perspective: T2D Disparities Beyond the US and Europe

As aforementioned, the prevalence of T2D in North America and Europe has increased significantly over the last decades. That said, the largest increases on a global level were recorded in low- and middle-income countries (LMICs), including the regions of Southeast Asia, South Asia, the Middle East, North Africa, and Latin America [10]. In 2017, the International Diabetes Federation estimated the prevalence of T2D in adults in the region to range between 4% in Nepal and 8.8% in India [94]. The pooled prevalence of diabetes in South Asia has surged, rising from 11.3% (2000–2004) to 22.3% (2020–2024) [95], a rise mostly associated with the changing lifestyles in the region, including urbanization and industrialization [96,97]. The Middle East and North Africa (MENA) region had the highest prevalence of diabetes in 2019, at 12.2% [98], with this number rising to 18% in 2021 [99]. Several countries in the Middle East have a particularly high prevalence of T2D, with Kuwait, Saudi Arabia, and Bahrain being among the top 10 countries worldwide based on T2D prevalence [100]. In 2021, Qatar had the highest prevalence and incidence rates of T2D in the MENA region [101]. From 1990 to 2019, the average incidence rates in the MENA region increased by nearly 80% [101], while this region also has the highest percentage (24.5%) of diabetes-related deaths in people of working age [102]. Similar to Southeast and South Asia, the increased prevalence of T2D in the MENA region is connected to increased obesity, rapid urbanization, and lack of exercise [103].

The above countries account for nearly 80% of the global diabetic population and face significant challenges in diabetes management due to limited healthcare access [47]. Many LMICs lack access to essential medicines, including insulin, with only 27% registering all insulins classified as essential by the World Health Organization and 22% registering none [104]. Comprehensive government provision of essential medications like metformin is limited in low-income countries compared to high-income countries [84]. Health system performance for diabetes management reveals significant unmet needs in LMICs, with a study across 28 LMICs showing large losses in care during the testing stage and low rates of diabetes control, with a total unmet need for diabetes care at 77.0% [105]. Managing diabetes in LMICs can be costly, posing a substantial financial burden on vulnerable populations, especially with OOP payments where people spend at least one-tenth of their annual household budget on health-related expenses [106]. The increase in T2D prevalence in LMICs will exacerbate existing health disparities, further worsening the already poor health outcomes faced by these populations. Indeed, there is a substantial gap in diabetes treatment, with nearly 60% of adults aged 30 and older remaining untreated, mostly in LMICs [107]. Similarly, a significant portion of people with diabetes globally remain undiagnosed, especially in LMICs [107]. Lastly, LMICs have higher diabetes-associated mortality than high-income countries for individuals over 50 years old [108].

This inequity will be further exacerbated due to the significant increases in T2D prevalence projected over the coming decades in the MENA region and a projected 150% increase in emerging economies by 2030 overall [46,47].

8. Future Directions and Conclusions

This review highlighted the critical interplay between modifiable and nonmodifiable risk factors, socioeconomic determinants, and disparities in healthcare access in the setting of T2D. The escalating global prevalence of T2D, projected to reach 1.3 billion by 2050, necessitates urgent action. While genetic predisposition, age, and ethnicity contribute to an individual’s risk, socioeconomic status emerges as a significant factor, influencing lifestyle choices, access to resources, and overall health outcomes. Campaigns focused on the prevention of T2D have shown significant success in various parts of the world. For instance, the NHS Diabetes Prevention Programme in England has been highly effective, reducing new diagnoses by 7% between 2018 and 2019, with participants experiencing a 37% reduction in their risk of developing T2D [109]. Similarly, the Diabetes Prevention Program (DPP) in the US demonstrated that lifestyle changes can lower the risk of T2D by 58% [110]. These programs focus on lifestyle modifications such as diet and exercise, which are universally applicable but may face challenges in other regions due to differences in healthcare infrastructure and cultural factors. In LMICs, implementing such programs can be more complex due to limited resources and access to healthcare services. However, initiatives like the World Health Organization’s Global Diabetes Compact aim to improve access to diabetes care globally, suggesting that with appropriate adaptation and support, similar prevention strategies could be effective worldwide [111].

The disproportionate burden of T2D among racial and ethnic minorities, coupled with the staggering economic and societal costs associated with the disease, underscores the urgent need for targeted interventions and policy reforms. It is thus evident that T2D is not only a result of socioeconomic inequality but also contributes to inequality, affecting populations that are already at risk for worse health outcomes and will have to face the costs and complications associated with T2D. Addressing these inequities requires a multipronged approach, encompassing accessible and affordable healthcare, culturally sensitive education programs, and policies that promote healthy environments and reduce socioeconomic disparities. By prioritizing prevention, improving management, and ensuring equitable access to care, the negative impact of T2D can be mitigated.