Commentary: socioeconomic position and the risk of type 2 diabetes.

As the incidence of type 2 diabetes rises in the developed world, researchers continue to work on characterizing modifiable risk factors that go beyond the traditional biomedical paradigm. The article by Maty et al. 1 examines the association between income, education, and occupation and the 34 year incidence of type 2 diabetes in the Alameda County Study. It also evaluates how time-dependent measures of socioeconomic position (SEP) might be associated with incident diabetes. The authors find that after adjustment for demographics, respondents with ,12 years of education had a 50% excess risk of diabetes compared with those with more education, but income and occupation were not significantly associated. Furthermore, time-dependent effects were not statistically significant after adjustment for demographics and other potential factors in the causal pathway. The authors should be commended for their attention not only to the contribution of SEP in the development of diabetes but also to SEP’s inherent time-dependency. They reference several previous studies that specifically examined the association between SEP and diabetes, but these studies are few compared with the much larger body of work examining biological and clinically-oriented risk factors. Increasing interest in this area is evident by a recent review article 2 that highlighted the significance of SEP in the development of diabetes as well as its affect on mediators and moderators for appropriate diabetes care and the development of diabetes complications. The impact of SEP is extremely important even after the development of type 2 diabetes. Work by our group suggests that socioeconomic and family needs must be addressed before patients can attempt traditional diabetes self-management, 3 that problems in an urban community (crime, money, housing) had a similar contribution to health-related quality of life as clinical parameters (hypertension, hypercholesterolaemia), 4 and that a multi-faceted intervention incorporating clinical, family, and community context is needed to improve diabetes control among African Americans with type 2 diabetes. 5,6