Diabetes Research Centre, University of Leicester, Leicester, U.K.
Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI.
Diabetes Care. 2023 Feb 1;46(2):228-236. doi: 10.2337/dc21-2495.
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
在 2019 年冠状病毒病（COVID-19）大流行之前，糖尿病治疗方面存在着明显的主要种族差异，尤其是在中间结果和糖尿病并发症方面。糖尿病是 COVID-19 重症的一个危险因素，这些糖尿病治疗和结果方面的种族差异的结合可能导致了糖尿病患者 COVID-19 结局的不平等。总体而言，少数民族人群 COVID-19 住院和死亡率不成比例地高。来自少数族裔糖尿病患者 COVID-19 研究的有限数量的研究结果不一，但有一些迹象表明，住院率和死亡率高于白人人群。少数民族群体 COVID-19 相关结局发生率和严重程度较高的原因很复杂，这是由于合并症（如糖尿病）、暴露风险（如过度拥挤的生活条件或必要工人的工作）和治疗机会（如医疗保险状况和获得三级保健医疗中心）的差异所致，这些都与长期存在的、因种族而异的结构性不平等有关。虽然已经发表了关于糖尿病自我管理以及大流行期间门诊和住院治疗的指南和方法，但很少有建议解决更广泛的结构性问题。由于我们现在正在为疫情后的恢复以及更好的监测和危险因素管理做计划，初级和专科保健服务机构迫切需要解决大流行对少数民族群体造成的不成比例的影响。这应包括关注社会中更大的结构性障碍，这些障碍使患有糖尿病的少数民族人群面临潜在的 COVID-19 结局不佳的更大风险。
