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Tightening the 'Diabetes Belt'

A new report by a federal agency has identified the southeastern United States as the nation's "Diabetes Belt." But HR leaders must make diabetes prevention and maintenance a top priority regardless of their location, experts say. 

By Michael O'Brien

While the news may not surprise anyone who's been watching the nation's waistline slowly expand over the years, a new report from the Centers for Disease Control and Prevention in Atlanta has identified 644 counties in 15 U.S. states as the "Diabetes Belt."

That belt winds through portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, as well as the entire state of Mississippi, according to "Geographic Distribution of Diagnosed Diabetes in the U.S.: A Diabetes Belt."

The report -- compiled by comparing demographics and risk factors of residents across the country, such as gender, age, education, lifestyle, obesity and race/ethnicity -- will be published in the April issue of the American Journal of Preventive Medicine and was written by lead investigator Dr. Lawrence E. Barker, along with co-authors Karen A. Kirtland, Edward W. Gregg, Linda S. Geiss and Theodore J. Thompson.

Nearly 12 percent of people living in that "belt" have diabetes -- which is characterized by the abnormal production of blood sugar -- compared to 8.5 percent of individuals in the rest of the nation, according to the report.

"Identifying a diabetes belt by counties allows community leaders to identify regions most in need of efforts to prevent type 2 diabetes and to manage existing cases of the disease," says Barker.

"Although many risk factors for type 2 diabetes can't be changed, others can," he says. "Community design that promotes physical activity, along with improved access to healthy food, can encourage the healthy lifestyle changes that reduce the risk of developing type 2 diabetes."

Currently, about 26 million Americans have diabetes, according to the Alexandria, Va.-based American Diabetes Association, and treatment costs for employers and patients total $100 billion annually. Sufferers are at risk for other medical conditions, including heart disease, kidney damage and some kinds of cancer.

Barker says organizations would be wise to focus their wellness efforts on diabetes prevention and maintenance even if their organizations are not located within the belt.

"Many costs are associated with diabetes, including increased absenteeism and more expensive medical care," he says. "Programs that encourage physical activity and weight loss can help reduce or avoid these costs.

"Addressing diabetes at work can be something as simple as giving employees a place to be physically active during lunch hour, or offering healthy alternatives in the cafeteria or vending machines," he says.

Dr. Carolyn Dean, medical director of the Orange, Calif.-based nonprofit Nutritional Magnesium Association, says climate may play a role in the prevalence of the disease in the south.

"The southeastern U.S. tends to be a more humid and hot environment," she says, "where people lose vital minerals, including magnesium, through perspiration -- minerals which help with blood-sugar control, pancreatic function and insulin sensitivity."

Diet is clearly another factor, she adds.

"Consumption of high-carbohydrate foods and drinks would make this study result make sense," she says.

She says that it's not enough for HR leaders to tell their people that they shouldn't drink "liquid candy" such as sodas.

"Take out the soda and diet-soda machines and the candy machines," she says. "Or put in water coolers or water bottles in the machines along with fruits and vegetables and magnesium supplements."

Most people, she says, are deficient in magnesium, which she calls "the safest treatment in the prevention of diabetes."

Meanwhile, Dr. Sue Kirkman, senior vice president for medical affairs and community information at the American Diabetes Association, says it is a "mixture" of factors that is causing the diabetes epidemic.

"Just like with everything else, there are cultural, financial as well as genetic" reasons for the belt, she says.

"Non-caucasians are more likely to be obese and to develop type 2 diabetes, and that part of the country has a lot of African-Americans and other minorities," she says. "And obesity [in the United States] is more a disease of poverty than wealth, and income is lower and socio-economic status is also lower [within the belt]."

To increase awareness of this manageable disease, the association is pushing its Join the Million Challenge. It hopes to get at least one million people to take a free, online assessment of their risk for diabetes by April 22 at www.stopdiabetes.com.

Kirkman says organizations that make concerted efforts to control diabetes within their workforce often see a return on their investment within just a few short years, compared to other wellness initiatives.

"[Such efforts] reduce healthcare costs over a fairly short amount of time if people get their diabetes under control," she says. "People are more likely to be productive at work if they have this under control."

While including more healthful food offerings in an organization's cafeteria is important, she says, price must be taken into consideration as well.

"If the salad is six bucks but the burger is only one dollar, that's obviously going to sway people one way or the other," she says.

With her organization located within the belt, Kirkman says, the 300 employees working at headquarters are offered, among other incentives, a subsidy for gym memberships in an effort to get them moving toward healthier lifestyles.

"It's all about keeping employees healthy and productive, and that's really the reason to do it," she says.

March 30, 2011