摘要：The US Department of Health and Human Services has developed an initiative called “Eliminating Racial and Ethnic Disparities in Health,” which parallels Healthy People 2010, the nation's health goals for the next decade. The initiative focuses on areas of health disparity that are known to affect racially and ethnically diverse groups of the population yet hold the promise of improvement. The first step to addressing such health inequities is to understand the scope and nature of the diseases that contribute to such disparities. This commentary reviews the epidemiology and consequences of type 2 diabetes, particularly as it is manifested in socially and culturally diverse groups, and offers recommendations for actions to address the disparities resulting from diabetes. DIABETES MELLITUS REFERS to a group of metabolic diseases that are characterized by hyperglycemia. In turn, hyperglycemia is caused by the body's inability to produce or effectively utilize enough insulin, a hormone that the body uses to convert food into glucose. As a result of this defect, the level of glucose in the blood becomes elevated—a condition commonly referred to as high blood sugar. Diabetes mellitus is currently classified into the following 4 categories, based on etiology: type 1 diabetes, which is usually diagnosed in childhood or early adulthood; type 2 diabetes, which is diagnosed in middle or old age; gestational diabetes, which occurs during pregnancy; and other, less common types of diabetes that result from genetic defects, drug or chemical use, infections, or other diseases. 1 The early symptoms of diabetes develop gradually and, as a result, often go unnoticed until serious damage has already been done to the body. Later symptoms or complications of the disease include neuropathy leading to ulcers and amputations, retinopathy leading to blindness, nephropathy leading to renal disease, atherosclerotic cardiovascular disease, peripheral vascular disease, cerebrovascular disease, hypertension, increased susceptibility to infections and prolonged recovery time, and lowerextremity amputations. 2 Diabetes is a costly disease. One out of every 7 dollars spent on medical care in the US is related to diabetes, 3 with an annual cost of over $100 billion, and diabetes accounts for more than 3 million hospital stays and more than 15 million physician visits each year. 4, 5 Although the majority of adults with diagnosed diabetes attempt to control the disease, they are substantially less healthy than nondiabetic adults. In addition to being at risk for diabetic complications, diabetics are at higher than average risk for comorbid health conditions, disability, depression, cognitive impairment, and poor quality of life. Diabetics also have higher rates of disability—almost 30% of those aged 45 to 60 years and over 45% of those 70 years and older report some form of disability, compared with only 10% to 20% of nondiabetics.
