Enhancing Diabetes Management for Sexual and Gender Minorities

Background and Importance of Addressing Diabetes Disparities

Diabetes, a chronic condition characterized by elevated blood glucose levels, poses significant health risks, particularly for marginalized populations. In the United States, diabetes prevalence is disproportionately high among Black and Hispanic communities, with these groups experiencing more severe complications and mortality rates compared to their white counterparts. Studies indicate that Black adults have a diabetes prevalence of 12.1%, and Hispanic adults 11.7%, compared to 6.9% for non-Hispanic whites (Shiyanbola et al., 2024). The disparities are exacerbated by social determinants of health (SDOH), such as economic instability, lack of access to healthcare, and systemic racism, which contribute to lower medication adherence and poorer health outcomes (Shiyanbola et al., 2024).

In addition to traditional risk factors, sexual and gender minorities (SGM) face unique challenges that compound their vulnerability to diabetes. These individuals often encounter stigma, discrimination, and barriers to accessing quality healthcare, which can hinder their ability to manage diabetes effectively. The need to address these disparities is critical, as untreated diabetes can lead to severe complications, including cardiovascular disease, kidney failure, and amputations.

Key Factors Contributing to HIV Risk in Sexual and Gender Minorities

For sexual and gender minorities, the intersection of diabetes and HIV presents a complex public health challenge. SGM individuals represent a significant proportion of new HIV infections in the U.S., with estimates suggesting that they account for more than two-thirds of new cases annually (Grov et al., 2025). This heightened risk is attributable to several factors, including behavioral, structural, and psychosocial determinants.

Behaviorally, methamphetamine use, prevalent in some SGM populations, has been linked to increased sexual risk behaviors, including condomless anal sex (CAS), which significantly elevates the likelihood of HIV transmission (Grov et al., 2025). Structurally, the communities in which many SGM individuals live often lack adequate healthcare resources, making it difficult for them to access necessary preventive measures such as pre-exposure prophylaxis (PrEP). Psychosocial factors, including stigma and minority stress, further complicate the situation by affecting mental health and increasing vulnerability to both diabetes and HIV.

Innovative Strategies for Optimizing Diabetes Care

To effectively manage diabetes among sexual and gender minorities, innovative and culturally competent strategies must be employed. One promising approach is the integration of Community Health Workers (CHWs) and pharmacists within diabetes care frameworks. Research indicates that CHWs can play a vital role in addressing SDOH barriers, providing education, and facilitating access to healthcare resources (Shiyanbola et al., 2024).

Chronic disease management programs that leverage the expertise of pharmacists in medication therapy management (MTM) have shown promise in improving diabetes outcomes. Pharmacists can conduct comprehensive medication reviews, optimize therapy, and provide education about diabetes management, yet many lack training in addressing SDOH and health misconceptions (Shiyanbola et al., 2024). By supplementing MTM with CHW services, healthcare providers can create a more holistic approach to diabetes care that encompasses both medical and social needs.

Table 1: Key Strategies for Optimizing Diabetes Management

Role of Community Health Workers in Diabetes Management

Community Health Workers are increasingly recognized as essential components of healthcare teams, particularly in managing chronic diseases such as diabetes. Their role extends beyond mere health education; they serve as liaisons between the healthcare system and the communities they serve. CHWs are well-positioned to identify and address barriers that SGM individuals face in managing their diabetes, including stigma, lack of access to culturally competent care, and misinformation about diabetes management.

Studies have shown that interventions incorporating CHWs can lead to significant improvements in diabetes outcomes, including reductions in hemoglobin A1c (A1C) levels and enhanced medication adherence (Shiyanbola et al., 2024). Their ability to provide tailored support and resources based on individual needs is crucial for empowering patients to take control of their health.

Future Directions for Research and Intervention in Diabetes Care

As we look to the future, it is imperative that research focuses on developing and testing interventions that are specifically designed for sexual and gender minorities with diabetes. This includes exploring the effectiveness of integrated care models that combine CHW and pharmacist-led services, as well as investigating the role of technology in enhancing diabetes management (Shiyanbola et al., 2024).

Further studies should also assess the impact of cultural competency training for healthcare providers, ensuring they are equipped to address the unique challenges faced by SGM individuals. Longitudinal studies examining the long-term effects of these interventions on diabetes outcomes among SGM populations will be vital in informing best practices and policy changes aimed at reducing health disparities.

Table 2: Future Research Directions

Frequently Asked Questions (FAQ)

What are the primary challenges faced by sexual and gender minorities in managing diabetes?

Sexual and gender minorities often face barriers such as stigma, discrimination, and lack of access to culturally competent healthcare, which can hinder their diabetes management efforts.

How can Community Health Workers improve diabetes outcomes for these populations?

Community Health Workers can provide tailored support, address social determinants of health, and enhance access to resources, leading to improved medication adherence and lower A1C levels.

What role do pharmacists play in diabetes management?

Pharmacists can conduct medication therapy management, optimize diabetes medications, and provide education about diabetes, but may require additional training to effectively address social barriers.

Why is cultural competency important in diabetes care?

Cultural competency ensures that healthcare providers understand and respect the diverse backgrounds of their patients, which can improve communication, trust, and health outcomes.

What are some innovative strategies for optimizing diabetes care?

Innovative strategies include integrating Community Health Workers and pharmacists, utilizing technology for diabetes management, and developing culturally competent care models.

References

1. Shiyanbola, O. O., Maurer, M. A., Piper, M. E., Bolt, D., Sharp, L. K., Ouayogoé, M. H., & Fisher, E. (2024). Optimizing diabetes management interventions for Black and Hispanic adults using the multiphase optimization strategy: Protocol for a randomized mixed methods factorial trial. Contemporary Clinical Trials, 107804. Retrieved from https://doi.org/10.1016/j.cct.2024.107804

2. Grov, C., D’Angelo, A. B., Mirzayi, C., Dearolf, M., Hoeppner, E., Guo, Y., Richards, N., Ehsan, R., Kulkarni, S., Nash, D., Patel, V. V., Duncan, D. T., Ray, M., Bartholomew, T., Manuzak, J., Manuel, J., McCollister, K., & Carrico, A. W. (2025). The American Transformative HIV Study: Protocol for a US National Cohort of Sexual and Gender Minority Individuals With HIV. JMIR Public Health and Surveillance, 3000. Retrieved from https://doi.org/10.2196/66921

3. Sun, Y., Sun, K., Ling, H., & Xia, Q. (2025). Farnesoid X receptor-driven metabolic plasticity: Bridging physiological adaptation and malignant transformation in lipid handling (Review). International Journal of Molecular Medicine, 1936. Retrieved from https://doi.org/10.3892/ijmm.2025.5551

4. Amador-Fernandez, N., Desselle, S., García-Cárdenas, V., Dineen-Griffin, S., & Benrimoj, S. I. (2024). Community pharmacy and selfcare provision: An international perspective. Exploratory Research in Clinical and Social Pharmacy, 4203. Retrieved from https://doi.org/10.1016/j.rcsop.2024.100466