Table 10.

Summary recommendations for future research

Race/ethnic disparities	Sex disparities
Diabetes mellitus
Future research needs: biological and clinical factors	Future research needs
Inclusion of specific ethnic subgroups in studies of diabetes epidemiology and physiology.	Determine whether the risk of type 2 diabetes occurs at different BMI and WC thresholds in NHB vs. NHW women.
Elucidate reasons for differences in diabetes prevalence and incidence and glucose metabolism in Cuban, Central, and South Americans compared to Mexican- and Puerto Rican-Americans.
Elucidate reasons for differences in diabetes prevalence and incidence among different Asian-American subgroups and the contribution of acculturation and immigrant status.
Elucidate other nonobesity contributors to the higher insulin resistance seen in minority populations compared to NHWs because these differences are independent of adiposity.
Basic science investigations needed to determine whether race/ethnic differences in insulin signaling contribute to greater insulin resistance in minority populations.
GWAS needed in minority populations
Design studies targeting perinatal prevention of fetal undernutrition and fetal-maternal stress as a diabetes preventive strategy in NHBs.
Future research needs: nonbiological factors
Determination of the contribution of acculturation to obesity and diabetes risk in Asian- and Hispanic-Americans.
Elucidation of diet, physical activity, and health behavior differences in minority populations compared to NHWs and their contributions to ethnic differences in diabetes risk.
Diabetes complications
Future research needs: epidemiology of complications	Future research needs
Epidemiological data summarizing prevalence and incidence of lower extremity amputation and arterial disease in Asian-Americans.	Elucidation of the etiology for higher coronary heart disease risk and lower peripheral arterial disease risk in women compared to men with diabetes.
Exploration of etiology of regional differences in diabetes and diabetes complication rates in Native Americans.	Determination of reason for sex differences on the effects of CVD risk factors in different arterial beds through basic science and clinical research studies.
Exploration of the etiology of heterogeneity in diabetes complications among Asian-American subgroups.	Studies of clinical and nonclinical contributors to diabetic complications stratified by sex and race/ethnicity, as suggested above.
Exploration of contributors to higher diabetes mortality in minority populations compared to NHWs.
Future research needs: biological and clinical factors
Studies of prevalence and control of glycemic and cardiovascular risk factors in minorities with diabetes mellitus.
Basic science, clinical, and population-based research studies to evaluate multifaceted (glycemic and nonglycemic) causes of ethnic variations in HbA1c, especially in Asian, Hispanic, and Native American populations (analogous to studies comparing NHBs and NHWs).
Basic science and clinical research studies to examine the contribution of low birth weight, fetal undernutrition, and fetal-maternal stress to microvascular complications in NHBs with diabetes mellitus.
Basic science, clinical, and translation research studies to determine the etiology of the survival advantage of NHBs on dialysis for diabetic nephropathy, which may lead to better understanding of how to improve survival in dialysis patients of other race/ethnicities.
Basic, clinical, and population-based research studies to determine the contributors to the higher risk of microvascular but lower risk of macrovascular complications among NHBs with diabetes.
Future research needs: nonbiological factors
Development of policies and interventions to remove barriers to self-monitoring of blood glucose in ethnic minorities with diabetes mellitus.
GDM
Future research needs: biological factors
Determine the prevalence of significant polymorphisms in the BetaGene Study in other high-risk populations for GDM, especially Asian-Americans.
Examine gene-environment interactions with clinical factors—adiposity, physical activity, and diet.
Future research needs: nonbiological factors
Determine contribution of social and economic factors to race/ethnic disparities in GDM: socioeconomic status, mental stress, built environment.
Examine the contribution of documented disparities in access to care in women with prior GDM on screening for GDM and type 2 diabetes, quality of care, and quality of life.
Metabolic syndrome
Future research needs	Future research needs
Determine whether current metabolic syndrome criteria similarly predict type 2 diabetes and CVD in NHBs and NHWs.	Determine whether race/ethnic-specific cutoffs for WC in the metabolic syndrome definition better identify NHB women at risk for metabolic disorders.
Determine whether race/ethnic-specific cutoffs for TG in the metabolic syndrome definition better identify NHBs at risk for metabolic disorders.
Determine whether race/ethnic-specific cutoffs for WC in the metabolic syndrome definition better identify Asian-Americans at risk for metabolic disorders.
Thyroid disorders
Future research needs	Future research needs
Determine whether the lower TSH in NHBs translates into bone and cardiac effects compared to NHWs.	Determine the etiology of the higher prevalence and incidence of autoimmune thyroid disease in women compared to men through basic science and clinical research studies.
Determine whether the lower iodine concentration in NHBs is clinically significant and contributes to development of goiter and hypothyroidism.	Determine whether lifestyle interventions to promote weight loss and physical activity in obese women will lower the risk of thyroid cancer.
Determine the etiology of differences in thyroid cancer incidence in Asian-Americans based on country of origin and in Native Americans based on region of residence in the U.S.	Determine the etiology of compromised thyroid cancer survival in men as targets for future interventions.
Develop interventions and policies to increase minority access to high volume surgeons and earlier intervention in centers with endocrine and surgical expertise.
Assess molecular pathways for thyroid cancer at a mutational level to determine whether there are differences by race, which may suggest different prognoses and targeted therapies.
Osteoporosis/metabolic bone disease
Future research needs	Future research needs
Determine non-BMD contributors to lower fracture rates in minority women compared to NHWs.	Generate data on fracture rates, risk factors for fracture, and incidence of disability and morbidity associated with fracture in minority men.
Vitamin D deficiency
Determine whether there are genetic factors or differences in cell signaling that contribute to the higher BMD in certain minority populations compared to NHBs.
Determine the etiology of the lower fracture risk in Asian-American women compared to NHW women despite lower BMD.
Determine whether novel skeletal traits—bone size, bone geometry, hip axis length—differentially predict fracture risk in NHW and minority women compared to BMD.
Develop intervention strategies to preserve BMD in NHW women and protect them from the osteoporotic fractures.
Determine why NHB women suffer higher mortality and disability after fracture than NHW women.
Develop interventions strategies to increase osteoporosis screening, diagnosis, and treatment in minority women to prevent fractures and their associated morbidities.
Develop intervention strategies to increase vitamin D supplementation in NHBs.
Conduct basic and translation science studies to determine whether race/ethnic differences in molecular signaling or vitamin D metabolism contribute to lower levels in NHBs.
Determine the prevalence of vitamin D deficiency in minority populations, particularly Asian and Native Americans.