Complications of diabetes unequally affect particular groups in our society and older people and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities.

We used a realist approach to review the literature, mapped the main areas where relevant evidence exists and explored the concepts and mechanisms which underpin intervention. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers and policy makers.

There was a dearth of studies with specific focus on diabetes care for older people with South Asian ethnicity in the UK, despite their higher risk and policies for individualised and culturally sensitive care. South Asians experience diabetes ten years earlier than White Europeans and are heterogeneous group who should be targeted for early intervention and research into ageing and cultural influences in diabetes prevention and care.

Broad themes of cultural competency; co morbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; and culturally meaningful measures of depression and cognitive impairment.

At policy level, the review enables the opportunity to inform care planning in different contexts which support effective diabetes care for ageing and diverse populations