lin, resulting in the failure of transport of sugars across cell membranes; the net result is elevated blood sugar levels (American Diabetes Association, 2000; Centers for Disease Control and Prevention, 2000a). In addition to being far more common, Type 2 diabetes is slower to develop, usually diagnosed in adults over age 40, and most commonly diagnosed in adults over age 60. The consequences of diabetes, such as blindness, kidney failure, neuropathy, ulceration, and foot amputation, develop over lengthy periods of time and appear later in life. The difference in rate of onset led to using this variable in the statistical formula once used to distinguish Type 1 from Type 2 diabetes (American Diabetes Association, 2000; HeliosHealth.com, 2000; Songer and Zimmet, 1995). This formula is no longer useful because Type 2 diabetes now appears in adolescents, especially in minority populations. As the age of onset differs dramatically across ethnic groups, we can expect that diabetes will be seen as a disease of aging only in those communities where it is late in onset. When Type 2 onset is early in life, individuals may fail to distinguish Type 2 from Type 1 and develop beliefs about the disease incompatible both with its biology and with recommendations for behavioral change.

Prevalence

Diverse groups show substantial differences in the prevalence of Type 2 diabetes and the frequency of various complications, including heart problems and end-stage renal disease (Karter et al., 2002). Higher diabetes rates have been documented in African-American communities across all social categories (Hendricks and Haas, 1991), though prevalence is highest among women (especially those who have been previously diagnosed with gestational diabetes), the elderly, and individuals who have a positive family history for diabetes, who have fewer years of formal education, who have lower incomes, and who live alone (Brancati et al., 1996; Gaillard et al., 1997; Hendricks and Haas, 1991; Lipton et al., 1993; McNabb, Quinn, and Tobian, 1997). Statistical comparisons show non-Hispanic African-Americans to be 1.4 to 2.2 times



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