Diabetes Disparities in Sexual and Gender Minorities—A Call for Tailored Clinical Strategies

Introduction and Objective: Sexual and gender minorities (SGM) face increased risk for chronic conditions related to systemic barriers and insufficient integration of social determinants into clinical protocols. This study examines associations between SGM status, race/ethnicity, and diabetes or pre-diabetes in U.S. adults to inform tailored screenings and interventions. Methods: Weighted multinomial and logistic regression models examined correlates of diabetes and pre-diabetes, including sexual orientation and gender. Data from the Behavioral Risk Factor Surveillance System (n=165,371; population N =90,602,717) were utilized, with adjusted odds ratios (OR) and 95% confidence intervals (CI) calculated. Results: Among participants, 8.85% had diabetes, 13.45% were prediabetic, 7.72% identified as sexual minorities, and 0.58% as transgender or gender diverse. Transgender men had higher diabetes odds than cisgender individuals (OR 1.68, 95% CI 1.03-2.43, p=0.034), while transgender individuals showed marginal significance (OR 1.56, 95% CI 0.99-3.39, p=0.059). Mental health status was (≥14 poor mental health days per month) linked to increased odds of diabetes (OR = 1.20, 95% CI: 1.05-1.37, p < 0.001). Pre-diabetes was less prevalent among SGM subgroups, including gay/lesbian (OR = 0.57, 95% CI: 0.38-0.86, p <0.007) and other SGM individuals (OR = 0.59, 95% CI: 0.38-0.93, p < 0.025). Native Hawaiian/Pacific Islander (OR = 2.04, 95% CI: 1.43-2.68, p < 0.001) and multiracial individuals (OR = 1.82, 95% CI: 1.34-2.43, p < 0.007) exhibited increased odds of diabetes. Conclusion: Our findings show links between diabetes risk, sexual orientation, gender identity, and mental health stress. Current screening guidelines overlook these risks, highlighting the need for tailored tools that integrate gender-affirming therapy and psychosocial stress. The lower pre-diabetes prevalence in SGM groups may indicate ineffective early detection and low primary care utilization. Evidence-based, inclusive strategies focusing on integrated care are essential to address diabetes disparities in SGM populations. Disclosure: J.A. McNeil: None. A. Wolfe: None. H. Xie: None.