Management of Type 2 Diabetes Mellitus in Native Americans and Alaska Natives: A Systematic Review

American Indian and Alaska Native (AI/AN) populations face a disproportionately high prevalence of type 2 diabetes mellitus (T2DM) compared to other U.S. racial and ethnic groups. Despite this burden, limited literature exists on effective, culturally sensitive interventions, highlighting a critical need for focused research in this population. This systematic review examines 28 studies on how self-management, clinical management, and community-based programs improve glycemic control, medication adherence, and patient engagement in AI/AN populations. Clinical management reveals widespread use of metformin but limited initiation of newer agents such as Sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. Interventions integrating traditional practices and community engagement consistently yielded better diabetes outcomes. Effective T2DM management in AI/AN populations depends on culturally sensitive, community-based approaches that enhance adherence and clinical outcomes. While clinical care evolves, incorporating culturally grounded strategies alongside optimized pharmacotherapy is essential. Future efforts should focus on integrated care models that respect cultural values and support long-term management to reduce diabetes disparities.