Aims/hypothesis <p>Precision diabetes medicine aims to improve the accuracy of prevention and treatment by tailoring care to individuals and subgroups. When applied appropriately, it can reduce health disparities in diverse populations; however, it may also exacerbate disparities if inequities in research or implementation persist. This review sought to: (1) assess how health equity and disparities have been examined in precision diabetes medicine research; (2) identify which aspects are most frequently addressed; and (3) synthesise the conclusions drawn.</p> Methods <p>A scoping review was conducted in PubMed and Embase, supplemented by a retrospective citation search. No filter was applied for publishing date; however, studies were limited to those written in English and the review period concluded on 6 May 2025 in Embase and on 4 May 2025 in PubMed. Full articles of all study types were included if they discussed precision diabetes medicine from a health equity perspective. Data charting was primarily performed through the extraction of verbatim quotes relating to health disparities, barriers, opportunities and actionable solutions to enhance equity.</p> Results <p>Of 182 articles identified, 34 met inclusion criteria. The most common determinant of disparities discussed was race or ancestry (<i>n</i> = 30). Frequently cited barriers included uneven representation of ancestries in research (<i>n</i> = 24), limited attention to social determinants of health (<i>n</i> = 7) and high costs restricting access (<i>n</i> = 18). Suggested solutions included inclusion of under-represented groups (<i>n</i> = 15), greater focus on social determinants (<i>n</i> = 8) and enhanced patient and public involvement (<i>n</i> = 8). Opportunities for improving equity included leveraging new technologies (<i>n</i> = 9) and real-world data (<i>n</i> = 5).</p> Conclusions/interpretation <p>The need to promote health equity in precision diabetes medicine is increasingly acknowledged, with achievable priorities including broader inclusion, and attention to social determinants of health and cost-effectiveness.</p> <p><b>Registration</b> PROSPERO registration ID CRD420251033223.</p> Graphical Abstract <p></p>