DIABETES: A FAMILY MATTERSharon A. Denham, DSN, RN

TYPE 2 DIABETES

24 million people have diabetes. 57 million pre-diabetes. 60+ million with metabolic syndrome (at risk

for the disease) Can be prevented or delayed 72% of seniors 65 or older have diabetes or

pre-diabetes (almost half have not been diagnosed)

Cost $218 billion (2007) Leading cause of serious complications

Estimated prevalence of diagnosed and undiagnosed diabetes in people aged 20 years

or older, by age group, United States, 2007

2.6

10.8

23.8

0

5

10

15

20

25

20-39 40-59 60+Age Group

Perc

ent

OVERWEIGHT AND OBESITY IN THE UNITED STATES

More than one third of U.S. adults—more than 72 million people—and 16% of U.S. children are obese.

Since 1980, obesity rates for adults have doubled and rates for children have tripled.

Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly.

COSTS OF DIABETES In 2008, roughly one in five hospitalizations

involved patients with diabetes, and inpatient diabetes care cost about $83 billion.

"Diabetes increases length of stay and therefore increases cost regardless of whether it is the primary reason for admission…”

Agency for Healthcare Research and Quality

OBESITY TRENDS* AMONG U.S. ADULTSBRFSS, 1990, 1998, 2007

County Specific Obesity Rates

Diabetes

Obesity and Diabetes

OBESITY CONCERNS Obesity in adults is defined by a body mass index (BMI)

of 30 or higher. 72 million residents now considered obese. Obesity rates higher among those 50 years and older. Highest among non-Hispanic black women, at 41.9% Childhood obesity more than tripled in the past 30

years. Those with higher levels of education were less likely to

be heavier than those with lower education levels. Medical costs for obese U.S. residents were $1,429

higher than for people of normal weight.

Kentucky = 31.5%Ohio = 28.8%West Virginia = 31.1%

OBESITY RISKS

Food affordability and accessibility

Portion size Consumer confusion:

What is appropriate? Easy access to fast

food Limited access to

nutritious foods

Fears of outdoors Video games & TV Fatigue No place to ‘get

active’ Automobile

dependent Aches and pains

Nutrition Concerns Activity Concerns

Economic Levels in Appalachian Region

High School Graduation

Rates in Appalachia

State Diabetes Rates

KentuckyOhio

West Virginia

AREAS OF DIABETES RISK

Tobacco Use Higher poverty and unemployment Lower educational levels Overweight Sedentary Lifestyles Nutritional Risks

OHIO UNIVERSITYAPPALACHIAN RURAL HEALTH INSTITUTE STUDIES (2004, 2006)

Told by a doctor you have diabetes or sugar

11.30%

7.81% 7.00%

0.73%

0.74%0.80%

1.35%

0.80%0.59%

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

AHRI 2006 BRFSS 2004 Ohio BRFSS 2004Nationwide

Per

cent

age

of R

espo

nses

Boarderline\Pre-Yes (Pregnant Female)Yes

Confidence Interval for ARHI "yes" is 9.91% to 12.69%Confidence Interval for BRFSS Ohio "yes" is "6.64% to 8.98%

OHIO UNIVERSITYAPPALACHIAN RURAL HEALTH INSTITUTE STUDIES (2009)

Diabetes rate is 12.5% for these counties.

DIABETES FINDINGS, ARHI (2009)

Rate living with diabetes that have attended a diabetes-management class is (46.4%), below the national rate (55.1%) & target (60%).

Rate living with diabetes that visit a dentist once annually is 58.2%, below target of 75%.

Rate living with diabetes who cannot afford to see a doctor is 26.3%.

Rate living with diabetes who cannot afford diabetes-related medication is 16.9%.

Rate living with diabetes who cannot afford test strips is 23.6%.

OBESITY (BMI), ARHI (2009)

30.7% of adults are obese and only 34.0% are a healthy weight.

Those obese or overweight are significantly more likely to report having a heart attack than healthy weight individuals.

Those obese or overweight are significantly more likely to have heart disease than healthy weight individuals.

27.0% engage in 20 minutes vigorous exercise at least 3 days a week (30% target).

Males (33.4%) significantly more likely to meet the vigorous exercise goal/females (21.1%).

OTHER RISKS, ARHI (2009) 25.6% reported smoking everyday or some

days; greatly exceeding the national rate of 19.3% and target of 12%.

Unable to afford a doctor 15.2%, above than the Ohio (12.4%) and national (13.5%) rates.

PREVENTION WORKS

Lifestyle interventions reduce diabetes risks Early treatment can reduce vision loss (50-

60%) Foot care can reduce amputations (45-85%) Early detection of kidney disease by lowering

B/P can reduce decline in kidney function (30-70%)

DIABETES IN APPALACHIA

Culturally unique region. Lack culturally sensitive diabetes education. Family and place are important to people of Appalachia. Lack family-focused diabetes education materials. Lack adequate primary care.

NO ONE IS COMING!!!!

DIABETES: A FAMILY MATTERPurposes: Use culturally sensitive approaches to address

diabetes risks in the Appalachian region Aim to increase healthy lifestyle actions, diabetes

prevention, and diabetes self-management

DIABETES: A FAMILY MATTER

Goals Change the picture of diabetes in Appalachia Use new ways to address diabetes. Involve local citizens in making a difference. Empower volunteers to be part of the

changes.

PROGRAM EXPECTATIONS Recruit a team of volunteer SUGAR Helpers Provide volunteer training sessions (18-20 hours) Support and work together with volunteers Work together in your county Use toolkit materials & activities Take part in evaluation activities Have fun while you are doing it!!!!

SUGAR HELPERS• Support to• Unite• Generations in the• Appalachian• Region

SUGAR HELPERS

Medical experts Diabetes educators Health professionals People with all the

answers!

Friends and neighbors that care.

Volunteers willing to give of self.

Persons that enjoy helping others.

Local people that want to make a difference.

What they are not! What they are!

THE 5 “CS” OF SUGAR HELPERS

Citizenship Community Civility Commitment Courage

FIRST DISSEMINATION & EVALUATION PROGRAM September 2009 – August 2010 8 Ohio teams (Athens, Hocking, Lawrence,

Meigs, Perry, Pike, Ross, & Vinton) County team of at 4-5 members Teams had 5 to 10 SUGAR Helpers Funding of $4,000 per county

CURRENT PROJECT

5 Continuing Ohio counties (Athens, Hocking, Lawrence, Perry, Ross)

3 new Ohio counties (Adams, Brown, Scioto) 3 Kentucky counties (Carter, Lewis, Rowan) 2 West Virginia counties (Mingo, Wayne)

WHAT’S IT ALL ABOUT? It’s about you and your family. It’s about the places where you live. It’s about working with others. It’s about finding answers that make a difference. It’s about making a year commitment. It’s about reaching out to those you care about.

TOGETHER!

WE CAN MAKE A DIFFERENCE

SUGAR HELPERS: WHAT DO THEY DO? Go through a training program that you

provide. Make diabetes more visible in your county. Become part of a team. Get involved. Listen to concerns. Work with others to become healthier. Give local people a voice. Use local resources to promote health. Empower other local people.

LUNCH TIME ACTIVITY Make a list of all of the towns in your county Identify at least one person in each town that

might be someone to get involved. Make a list of these people and decide who

will contact them. Identify three opinion leaders to tell about

the program. Identify 1-3 local heroes to involve.