Intended for healthcare professionals


Social aetiologies of type 2 diabetes

BMJ 2018; 361 doi: (Published 27 April 2018) Cite this as: BMJ 2018;361:k1795
  1. Lauren Carruth, assistant professor1,
  2. Emily Mendenhall, assistant professor2
  1. 1School of International Service, American University, Washington, DC, USA
  2. 2School of Foreign Service, Georgetown University, Washington, DC
  1. Correspondence to: L Carruth lcarruth{at}

For millions, type 2 diabetes is a disease of crisis and displacement not poor lifestyle choices

Diabetes kills more people around the world than HIV/AIDS, tuberculosis, and malaria combined, and most of these deaths occur in low or middle income countries.1 For many patients in these countries, insulin resistance may be better understood as a consequence of crisis, displacement, and trauma, rather than as a product of poor dietary or lifestyle choices. We must therefore reconsider our epidemiological understanding of risk for type 2 diabetes, and reform clinical advice in response.

Evidence shows that experiences of violence and marginalisation shape the risks and experiences of type 2 diabetes around the world,23 particularly among indigenous, colonised, and forcibly displaced populations.4567 More specifically, the humanitarian crises, food insecurity, and consumption of food rations that have often resulted from colonisation and displacement have important effects on the epidemiology and clinical management of type 2 diabetes.45

Most contemporary medical and public health discourses on diabetes, however, emphasise individual dietary and lifestyle choices in …

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