Socioecological Determinants of Prediabetes and Type 2 Diabetes: Agenda for Action

Since the latter half of the 20th century, increases in the rate of type 2 diabetes have closely followed increases in obesity in the United States. One-third of U.S. adults and 16–18% of young people are obese,1 and 35% of adults ≥ 20 years of age have prediabetes and therefore an increased risk for developing type 2 diabetes.2Fortunately, research shows that type 2 diabetes may be prevented or delayed with lifestyle modifications resulting in a loss of 7% of body weight and ≥ 150 minutes/week of moderate physical activity.3 The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes—2014”4 also recommends nutrition therapy and physical activity as part of a treatment plan for individuals with diabetes.As identified in the ADA scientific statement “Socioecological Determinants of Prediabetes and Type 2 Diabetes,”5 social and environmental factors also contribute to increased diabetes risk, diabetes complications, and morbidity. Considering this, it is important for health care professionals (HCPs) to recognize the intersection of these social and environmental factors when treating individuals with or at risk for type 2 diabetes. In addition, HCPs have many opportunities to serve as advocates for policy changes that could positively affect their local environment and complement the work they do in the clinical setting.This article describes the built, food, school, and work environments that were identified in the ADA statement5 as affecting diabetes and obesity risks and proposes some policy solutions to address the socioecological determinants of diabetes risk.The built environment refers to “environments that are modified by humans, including homes, schools, workplaces, highways, urban sprawl, and accessibility to amenities, leisure, and pollution.”6 Research indicates that socioeconomically disadvantaged groups, including racial and ethnic minorities, people in rural areas, and other diverse underrepresented populations, tend to live in …