A 2026 narrative review found that suicide risk among Black men with diabetes has been studied only minimally. The review found no population-based or long-term follow-up study reporting suicidal thoughts, suicide attempts or suicide deaths specifically in this group.
The gap is even larger for Black gay, bisexual and other sexual minority men with diabetes. The review found no study that estimated suicidal thoughts, attempts or deaths in this population.
What the available research shows
One directly relevant study, published in 2010, compared 412 African American adults with type 1 diabetes with 404 African American adults without diabetes. Lifetime suicide attempts were reported by 13.3% of participants with diabetes and 3.5% of those without diabetes.
That study did not report separate results for men, so it cannot provide a suicide-attempt estimate for Black men with type 1 diabetes. Within the diabetes group, suicide attempts were linked with being female, depression, childhood trauma, hostility, smoking, and alcohol or drug misuse.
Broader research offers context but does not resolve the specific question. A 2017 meta-analysis of 54 studies found that diabetes was associated with a 56% higher overall suicide risk, with a relative risk of 1.56 and a 95% confidence interval of 1.29–1.89. The same analysis reported more than double the risk in type 1 diabetes, with a relative risk of 2.25.
A 2024 meta-analysis of 31 studies in adolescents and young adults with type 1 diabetes estimated suicidal thoughts at 15.4% and suicide attempts at 3.5%. Those estimates were imprecise, varied widely between studies and were not clearly higher than estimates in peers without diabetes.
Why the evidence gap matters
The available studies cannot show whether diabetes raises suicide risk more for Black men than for White men. They also cannot provide a prevalence estimate for Black men with diabetes or establish a combined “triple jeopardy” effect for Black sexual minority men with diabetes.
The review points to several possible sources of distress: depression, diabetes distress, treatment fatigue, complications, role loss, discrimination in health care, cost barriers and financial pressure. It distinguishes diabetes distress—the emotional burden of living with diabetes—from depression and says they should be considered separately.
Among 163 Black adults with type 2 diabetes in one study, including 85 men and 78 women, men reported more racial discrimination in health care than women. Discrimination was linked to higher hemoglobin A1c in men but not in women. The review attributes racial disparities in type 2 diabetes and its complications to structural racism and its consequences, rather than inherent biology.
For Black sexual minority men, the review describes racism, heterosexism, identity concealment, family rejection, housing or financial instability and isolation as relevant stressors. Research among Black sexual minority men has linked discrimination based on race and sexual orientation with psychological distress and depression. Studies of young Black sexual minority men have also linked anticipated discrimination with suicidal behaviors, while identifying positive identity and other personal strengths as possible buffers.
Implications for primary care
The review recommends that primary care clinicians ask about diabetes distress and suicide risk despite the limited evidence. It cautions against assuming that missed insulin doses, uneven medication use or unstable blood sugar represent self-harm without asking the person directly.
Screening tools discussed in the review include the PHQ-9, whose final item asks about thoughts of death or self-harm; the Diabetes Distress Scale; and the Columbia-Suicide Severity Rating Scale, a structured interview about suicidal thoughts and behavior. Their accuracy in Black men with diabetes has not been established. The review does not show that these tools work worse in this group; rather, the evidence has not yet been collected.
The review says such tools should open a conversation rather than replace one. Its primary-care framework includes identifying distress, assessing suicide risk, asking about context, responding with safety planning and referral, and providing ongoing support. It also says safety planning should address access to medications, including insulin, and other lethal means such as firearms, while warning that abrupt or punitive insulin restriction can be medically dangerous and damage trust.
What researchers say is needed next
The review calls for long-term studies that include enough Black men and Black sexual minority men to analyze them separately. It also recommends distinguishing type 1 from type 2 diabetes and testing how well depression, diabetes-distress and suicide-risk tools perform in these populations.
For now, the central finding is the absence of direct evidence. Adjacent studies can suggest possible pathways, but they cannot establish causation or explain how diabetes, race, gender and sexual identity may interact in suicide risk.
The source identifies the U.S. 988 Suicide & Crisis Lifeline as a resource for people who are struggling.
AI tools were used to assist with the preparation of this article under our editorial standards.
Leave a Reply