Invited commentary: untangling the web of diabetes causality in African Americans

Diabetes is more prevalent and its consequences more severe in African Americans than in Whites. Efforts to understand and eliminate the root causes of disparities in the prediabetic state offer the potential to reduce the tremendous "downstream" costs of diabetes for patients and society. The accompanying study by Schootman et al. (Am J Epidemiol 2007;166:379-387) presents provocative new data on the apparently significant role of an individual's own housing condition in the odds of subsequent diabetes development. Despite methodological limitations in measurement and adjustment for confounding, this paper offers new insights into potential mediators of diabetes development. Efforts to effectively address the problem of disparities in the prediabetic state will require greater interdisciplinary collaboration between unfamiliar disciplines and wider implementation of the randomized clinical trial design.