Managing More Than Diabetes: The Self-management Experiences of Black Older Adults Living in the Suburbs With Prediabetes or Diabetes

OBJECTIVES: Diabetes disproportionately affects Black populations in Canada, yet little is known about how Black older adults navigate self-management in everyday life. Existing research often emphasizes biomedical outcomes while overlooking racism, cultural identity, and aging. This study explores how Black older adults living with prediabetes or diabetes in suburban Toronto, Ontario, understand and carry out self-management, using an intersectional lens. METHODS: We conducted a qualitative study with 21 English-speaking Black immigrants 55 to 83 years of age and living with diabetes or prediabetes in suburban Ontario. Participants were recruited through Black-led community organizations, health and social agencies, and peer networks. Semistructured interviews were transcribed verbatim and reviewed for accuracy. Data were analyzed using the DEPICT model, combining inductive coding with deductive attention to intersectionality and Jones's 3 levels of racism (institutional, personally mediated, internalized). Strategies to ensure trustworthiness included field notes, investigator triangulation, and peer-researcher validation. RESULTS: The analysis revealed an overarching theme of racism and epistemic injustice in health care, shaping every dimension of diabetes self-management. Participants described balancing biomedical advice with cultural traditions, adapting diets, physical activity, and medications while maintaining cultural identity. Emotional and financial pressures, coupled with limited provider engagement, left many to self-educate and rely on peer support. Family members, especially women, played central roles in meal planning and monitoring, which provided support but also introduced tensions around autonomy and household decision-making. CONCLUSIONS: Black older adults in suburban Toronto, Ontario, manage diabetes in ways shaped by culture, family, and systemic racism. These findings challenge individualistic models of self-management and highlight the need for relational, equity-oriented, and culturally responsive care that explicitly addresses anti-Black racism and supports community-led approaches.