A joint symposium of the American Diabetes Association^® (ADA) and the American Society of Nephrology (ASN) will feature a panel of nephrology and diabetes professionals who will discuss the psychosocial determinants of health in kidney disease and diabetes, including the impact of race, ethnicity, and underrepresentation of vulnerable populations in clinical trials.

How Do We Address the Psychosocial Determinants of Health in Diabetes and Kidney Disease? will be held on Monday, June 26, at 1:30 p.m. PT in Room 28 of the San Diego Convention Center. This session also will be available via livestream for registered meeting participants.

Titilayo O. Ilori, MD, MSc, Assistant Professor of Medicine in the Division of Nephrology at Boston University School of Medicine, will discuss the impact of structural racism on diabetic kidney disease (DKD), including its biological effects and its contribution to disparities.

“Certain racial and ethnic groups, such as Black, Hispanic, American Indian, Alaska Native, and Pacific Islander people, have significantly higher rates of chronic kidney disease development compared to white individuals,” Dr. Ilori said.

Besides biological and genetic factors, psychosocial factors and social determinants of health also influence DKD outcomes in these populations, she continued.

“Racism extends beyond interpersonal discrimination and permeates all institutions, creating a racially hierarchical social structure,” Dr. Ilori said. “Addressing structural racism is crucial in mitigating inequities in kidney diseases, particularly diabetic kidney disease.”

Allison Dart, MD, a pediatric nephrologist and Clinician Researcher at the Children’s Hospital Research Institute of Manitoba and Associate Professor in the Department of Pediatrics and Child Health at the University of Manitoba, Canada, will discuss early onset kidney disease in disadvantaged youth with type 2 diabetes and the societal and structural barriers and mental health challenges they face.

“When we look at the whole youth-onset type 2 diabetes population, about 40% to 60% of them live in poverty and come from disadvantaged backgrounds, and many of them experience adverse mental health conditions like depression, anxiety, and a high burden of stress,” Dr. Dart said. “We are also seeing high rates of early-onset kidney disease in this young population, and we’ve learned that ignoring their mental health and psychological factors limits their ability to manage their chronic disease and exacerbates their risk of kidney disease.”

Psychological health in youth with type 2 diabetes is linked with an increased risk of kidney disease, and Dr. Dart and others are working to develop new care models that address the impact of structural determinants of health on youth, the high burden of mental health conditions they face, and the importance of addressing mental health as part of their care.

“We’re now actually looking at novel strategies to provide them with mental health support that can then help them with their self-management for their diabetes, and hopefully decrease complications like diabetic kidney disease and decrease the high rates of dialysis that we’re seeing in this population,” Dr. Dart said.

Shohinee Sarma, MD, MPH, FRCPC, an endocrinologist at Beth Israel Deaconess Medical Center and PhD student at the University of Toronto, Canada, will discuss the need for increased representation of indigenous and underrepresented groups in DKD research.

“This is such an important topic because the field has changed so dramatically in the last few years as the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors and new medications such as glucagon-like peptide-1 (GLP-1) receptor agonists have changed the way we provide diabetes care,” Dr. Sarma said. “However, when we look at these clinical trials, we see that representation of certain ethnicities and certain groups of people is pretty minimal, and these are vulnerable groups that we know are at increased risk with the consequences of diabetes.”

Improving representation in clinical trials begins with improving relationships in communities, she said.

“As we embark on a new era of diabetes research, we must improve representation of historically underrepresented groups in diabetes clinical research, but it can only happen with strong partnerships with communities,” Dr. Sarma explained. “There is a very long history of unethical research in vulnerable groups of people, which has raised barriers as to how we are able to connect with communities, but we have to find ways of engaging with and partnering with communities so that we can do better research to prevent the complications of diabetes, such as diabetic kidney disease.”