Differences in Modifiable Risk Factors Contribute to Increased T2D Risk Among Blacks

Nurse with patient
Nurse with patient
Differences in traditional modifiable diabetes risk factors between black and white individuals may contribute to the racial disparity in diabetes incidence in middle age.

Black and white young adults may not have a statistically significant disparity between races regarding the risk for incident type 2 diabetes developing during middle adulthood after adjustment for modifiable risk factors, according to a study published in the Journal of the American Medical Association.

From 4 urban US communities, researchers identified 4251 individuals, of whom 2066 (49%) were black and 2304 (54%) were women; their average age was 25 years. Individuals were followed for an average of 24.5 years. The purpose of this study was to determine the association between racial disparity in diabetes development between middle-aged black and white men and women, and its association with modifiable behavior, biological, neighborhood/location, psychosocial, and socioeconomic risk factors in young adulthood.

Study results demonstrated that overall, black men (hazard ratio [HR] 1.67 [95% CI 1.28-2.17] risk difference [RD] 47 cases/1000 people [95% CI, 15-78]) and women (HR 2.86 [95% CI 2.19-3.72] and RD 89 cases/1000 people [95% CI 61-117]) were at higher risk and diabetes was more likely to develop in these groups compared with white men and women. In addition, biological factors between black and white individuals were found to be the strongest associated disparity risk factor for diabetes development in both women and men (percent reduction in β, 112% and 86%, respectively). 

However, when adjusted for biological, socioeconomic, neighborhood, psychosocial, and behavioral factors, a disparity in diabetes risk did not exist between black and white middle-aged adults for both women (HR 0.79; 95% CI, 0.55-1.14) and men (HR 0.92; 95% CI, 0.62-1.38).

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Investigators concluded that while there was a statistically significant increased risk in overall development of type 2 diabetes in black men and women compared with white men and women, there was no longer a disparity when adjusted for modifiable risk factors during youth and adulthood in all individuals. 

Clinicians should encourage all patients to work to improve modifiable risk factors that have the potential to reduce significantly the risk for type 2 diabetes developing.


Bancks MP, Kershaw K, Carson AP, Gordon-Larsen P, Schreiner PJ, Carnethon MR. Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood. JAMA. 2017;318:2457-2465.