Inequities in type 2 diabetes

1 minute to Read + 2 minutes to Delve
He Ako Hiringa
30 March 2021
Bulletin #1

If you would like to view a PDF version of the bulletin, click here.

Inequities in type 2 diabetes

Māori and Pacific peoples have a higher incidence of type 2 diabetes and have worse health outcomes associated with the disease, compared with Europeans. Although differences in genetic predisposition may be involved, this does not explain the extent of the disparity.1,2

Many of the contributing factors are related and, in general, are likely to be due to inequities in standard of care, including access to medicines, medicines management, education and access to diabetes management services.2

  • Type 2 diabetes presents earlier in Māori, Pacific and Indo-Asian people than in others and delayed management may lead to poorer long-term health outcomes.2
  • Māori and Pacific people may be less likely to have their HbA1c checked at the recommended interval and rates of monitoring for renal failure (albumin creatinine ratio – ACR) may be lower in Maori compared with non-Maori.3
  • Māori and Pacific adults are more than twice as likely not to have collected a prescription because of cost than non-Pacific and non-Māori adults, after adjusting for age and sex differences.4
  • Māori are at increased risk of diabetic complications compared with non-Māori, including microvascular disease (nephropathy, retinopathy and neuropathy) and long-term macrovascular outcomes (coronary artery disease, stroke and peripheral vascular disease).1,2,5
  • Māori and Pacific people have a higher rate of progression to end-stage renal disease (ESRD) than European/other ethnicities.6
  • Māori have higher rates of retinopathy, limb amputation and mortality, compared with non-Māori.1,2,5
  • Māori and Pacific patients have significantly higher hospital admission rates and development of complications such as hypoglycaemia, cellulitis, renal failure and CVD compared with Europeans.1,2

The first step to addressing inequitable health outcomes is knowing that they exist.

Inequality vs. inequity

The words inequality and inequity are often used interchangeably in health yet there are important differences in their meaning.7

Health inequality refers to the health status of individuals or groups not being equal (eg, young adults tend to be healthier than elderly adults).7

If the difference is considered preventable, unfair, or due to bias in the way a group is treated, it is described as a health inequity (eg, Māori people generally have poorer health outcomes than non-Māori).7

Equality can be achieved by giving everyone the same amount of care.
Equity can be achieved by giving more care to those who need it.

Health inequities in the detection and management of diabetes and its associated health outcomes are significant concerns in New Zealand.


  1. Yu D, Zhao Z, Osuagwu UL, et al. Ethnic differences in mortality and hospital admission rates between Māori, Pacific, and European New Zealanders with type 2 diabetes between 1994 and 2018: a retrospective, population-based, longitudinal cohort study. Lancet. 2021;9(2), e209-e217.
  2. Harwood M, Tipene-Leach D. Chapter 9. Diabetes. In Robson B, Harris R. (eds). 2007. Hauora: Māori Standards of Health IV. A study of the years 2000-2005. Wellington: Te Rōpū Rangahau Hauora a Eru Pōmare.
  3. Health Quality & Safety Commission New Zealand. Atlas of Healthcare Variation. Diabetes. Accessed February 2021
  4. New Zealand Health Survey. Annual Data Explorer. November 2019. Accessed March 2021.
  5. New Zealand Ministry of Health. Māori Health Statistics. Health Status Indicators. Diabetes. Accessed March 2021.
  6. Huria T, Palmer S, Beckert L, et al. Inequity in dialysis related practices and outcomes in Aotearoa/New Zealand: a Kaupapa Māori analysis. Int J Equity Health 2018;17(27).
  7. Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories, Global Health Action, 2015;8(1). DOI: 10.3402/gha.v8.27106

Content updates

  • 25 July 2022: References updated throughout bulletin.