Skin Deep: Enhanced Variable May Help Explain Racial Disparities in Type 2 Diabetes and Prediabetes

INTRODUCTION: The study refined definitions of type 2 diabetes and prediabetes (Pre-/T2D) via its four-category outcome variable. Respondents were identified as Pre-/T2D on the basis of (a) doctor’s diagnosis only (i.e., managed Pre-/T2D); (b) biomarker only (i.e., undiagnosed Pre-/T2D); or (c) both diagnosis and biomarker (i.e., unmanaged Pre-/T2D). The reference was Pre-/T2D not indicated. We linked the outcome to social structural and social support factors, health care-related factors, mental disorder, and lifestyle variables, for each racial/ethnic group. METHODS: We used the 2011–2012 and 2013–2014 National Health and Nutrition Examination Surveys to measure the four-category outcome and examine race/ethnicity’s role in explaining the outcome. RESULTS: We found Pre-/T2D to be associated with age, BMI, physical activity, income, education, receiving health services, and other factors. A moderating role for race/ethnicity was also confirmed. CONCLUSION: The racial disparities observed in our three main categories generally resulted from high levels of undiagnosed Pre-/T2D and high levels of diagnosed but unmanaged Pre-T2D. Race/ethnicity’s moderating role generally indicated that, through the factors BMI, age, and receiving health services, minority status (with its attendant disadvantages) could facilitate undiagnosed Pre-/T2D as well as Pre-/T2D indicated concurrently by diagnosis and biomarker.