538-P: Multilevel Behavioral Drivers of Type 2 Diabetes Disparities in the United States-An Integrative Review

Introduction: Type 2 diabetes (T2D) disproportionately impacts minority populations. The National Institute of Minority Health and Health Disparities (NIMHD) Research Framework identifies drivers of health disparities across multiple levels and domains. This study synthesized evidence on the behavioral drivers of T2D disparities among minority populations in the US and categorized them across individual, interpersonal, community, and societal levels. Methods: Relevant articles were retrieved from PubMed, CINAHL, PsycINFO, and Scopus. Eligible studies, defined as studies published between 2017 and 2023 that report glycemic measures or differences in T2D prevalence or related outcomes for US minority populations were abstracted and summarized descriptively. Results: Of the 108 included studies, 28 (26%) addressed behavioral drivers or strategies for addressing T2D disparities, the majority of which were at the individual level 20 (71%), 7(25%) at the community level, and 1(4%) at the interpersonal level. Individual-level drivers included physical activity, dietary practices, dysfunctional eating, sleep quality and duration, health-seeking behavior, and coping strategies such as anxiety, stress, depression, or distress. The interpersonal-level factors were emotional and maternal abuse. The identified community-level interventions to improve T2D outcomes included lifestyle interventions, self-management education, and interventions aimed at improving resilience. No identified behavioral factors at the societal level. Conclusions: This review identified a persistent focus on individual-level behavioral drivers of T2D disparities. Given the clear evidence that disparities in T2D are the result of upstream factors, more studies are needed at the interpersonal, community, and societal levels to inform comprehensive interventions and policies aimed at reducing T2D disparities.