Published online Jun 15, 2014. doi: 10.4239/wjd.v5.i3.296
Revised: April 19, 2014
Accepted: May 13, 2014
Published online: June 15, 2014
Processing time: 180 Days and 14.8 Hours
Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with short-term health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature (n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistently affect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.
Core tip: Social determinants of health and diabetes need to be considered when focusing on improving diabetes outcomes. Future research studies should focus on testing health outcomes of people with diabetes within the social determinants of health framework. Such research is particularly significant due to high rates of diabetes and subsequent disease sequelae.