Although the risk of developing diabetes is high among US sexual minorities (SM) (lesbian, gay, bisexual), little is known about diabetes management in this population. We examined the impact of sexual orientation on current US diabetes management levels in a geographically diverse sample of people with diabetes (PWD).

Adult PWDs were identified from the 2015–2018 cross-sectional Behavioural Risk Factor Surveillance System surveys. We determined the unadjusted percentage and the adjusted odds ratios (OR) of noncompliance with American Diabetes Association (ADA) diabetes management measures (< 1 eye exam annually, < 1 foot exam annually, < 1 blood glucose check daily, < 2 A1C tests annually, no receipt of annual flu vaccination, never receiving pneumococcal vaccination, never taking a diabetes management course) in PWDs by SM status.

Unadjusted analyses revealed a high level of noncompliance with diabetes management among SMs and especially for annual flu vaccination (40.1–52.3%) and diabetes management education (38.4–48.4%). Compared to heterosexuals, lesbian women were more noncompliant for most and bisexual men and bisexual women for all diabetes management measures. We observed that SMs had slightly higher adjusted levels of noncompliance than heterosexuals only for annual foot exams (OR: 1.09, 95% confidence interval (CI): 0.81–1.46) and diabetes management education (OR: 1.06, 95% CI: 0.81–1.41).

High levels of noncompliance with ADA diabetes management guidelines in SM PWDs indicates a need for additional efforts to elucidate the factors that contribute to noncompliance in SMs, information that can be used to develop appropriate interventions to improve diabetes management for this population.