Scientific Statement: Socioecological Determinants of Prediabetes and Type 2 Diabetes

In this article, we examine the socioecological determinants—the biological, geographic, and built environment factors—that influence risk for prediabetes and type 2 diabetes. A socioecological perspective looks beyond the individual to evaluate a multitude of influences, from the surrounding home, work, school, and community environments to social determinants and the influence of public policy on individual behavior (1). Figure 1, adapted from the Institute of Medicine socioecological model of childhood obesity, provides a good framework for understanding potential socioecological determinants of risk for type 2 diabetes. Figure 1 Levels and sectors of influence on obesity and diabetes risk (progress in preventing childhood obesity) (© 2007 the National Academies Press). SES, socioeconomic status. In November 2012, the American Diabetes Association Prevention Committee convened a writing group to review the evidence on socioecological factors contributing to recent increases in prediabetes and type 2 diabetes. Drawing from the work of the committee, in this article we review the overarching evidence-based contributions of socioecological factors to risk for type 2 diabetes. Rather than incorporate the entire universe of relational observations, this scientific statement is intended to evaluate the extent to which data indicate a contributing role of social and environmental factors to the current epidemic of type 2 diabetes. The world is in the midst of parallel and rapidly advancing epidemics—obesity and type 2 diabetes—that began in the latter half of the 20th century and continue to grow, unchecked. Current prevalence rates are staggering and are expected to continue to climb over the ensuing decades. In the U.S., one-third of adults and 16–18% of youth are obese (2), up from 5 to 6% three decades ago (Fig. 2). Increases in rates of type 2 diabetes have closely followed the increases in obesity. In the U.S., diabetes affects 8.3% of the population, including 18.8 million with diagnosed …