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To the Editor: Dr Brancati and colleagues¹ found that even after adjustment for potentially modifiable factors, the relative risk (RR) for diabetes was higher for African American women vs white women than it was for African American men vs white men. We wish to suggest 2 possible explanations for this finding.

First, among white women, high parity might² or might not³ be a risk factor for type 2 diabetes. A study of older white women has shown that the association between parity and increased insulin resistance is discernible at ages 50 to 89 years,⁴ many years after childbearing. African American women may experience an even greater increase in insulin resistance than white women in association with multiparity as is suggested by evidence from a longitudinal study.⁵ African American women with multiple pregnancies had waist-to-hip ratio increases twice as great as African American women with no pregnancies, whereas white women with . . . [Full Text of this Article]