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[IP] Diabetes in the Delta - USA TODAY article (attempt #2)

Sorry the last link didn't work folks. I'll try it again... 



Diabetes in the Delta
Wed Jan 8, 7:52 AM ET 

Anita Manning USA TODAY 

CLEVELAND, Miss. -- In this rural Mississippi Delta community, 100 miles and 
about a thousand cotton fields south of Memphis, Scott Nelson is on the 
front lines of the diabetes epidemic in the USA. 

A family doctor who treats patients with all manner of illnesses, he has 
seen a growing part of his practice devoted to that one disease. In this 
clinic, six doctors and two nurse practitioners see as many as 38 diabetes 
patients a day, along with about 250 other patients. 

Many live in Sunflower County, where nearly one in five residents has 
diabetes, the highest incidence in Mississippi. 

It's no coincidence, Nelson says, that Mississippi, which has a large black 
population, claims the highest obesity rate in the country: 25.9%. Diabetes 
affects people in all ethnic groups, but type 2, or ''adult-onset,'' 
diabetes is more common among minorities, older people and those who are 

The Centers for Disease Control and Prevention (news - web sites) says 
diabetes has been on the rise for the past two decades. From 1980 to 2001, 
prevalence rose from 2.77 per 100 people to 7.9 per 100. Most of the USA's 
17 million diabetics (news - web sites) have type 2, which is caused by 
insulin resistance -- the inability to make enough of the hormone insulin or 
to use it efficiently to convert sugar in the blood into energy. Type 1 
diabetes, which is caused by the body's destruction of its own 
insulin-producing cells, is less common; it affects about 10% of diabetics 
and is not associated with obesity. 

Genetics set the stage for type 2 diabetes, but environmental factors -- 
including obesity, which increases insulin resistance -- are believed to 
trigger the disease. Several studies have shown that diabetics who exercise 
and lose weight are better able to keep their blood-sugar levels in a safe 
range and in some cases can bring them back to pre-diabetes levels. 

Studies also show that people at high risk of developing diabetes can 
prevent it in many cases by exercising moderately and losing 5% to 7% of 
their body weight. 

Sedentary lifestyle 

What causes this part of Mississippi and much of the Deep South to have 
higher rates of diabetes is a mix of family history, changing social mores 
and diet, says James Gavin, president of Morehouse School of Medicine in 
Atlanta and chairman of the National Diabetes Education Program. 

People today are ''more sedentary, and they're eating by far and away more 
calories than they're expending. People have changed their styles of work 
and play. We've become more mechanized in what we do, so we have to make 
choices to compensate.'' 

Decades ago, ''physical activity was something we didn't have to think so 
much about. It's how we lived,'' Gavin says. ''The consequences of these 
changes are far more robust in high-risk populations because of the coupling 
of the genetic risk.'' 

And good old Southern cooking doesn't help. 

''The traditions of the Delta play a role,'' says Nelson, a third-generation 
resident of this community. ''We have deep familial roots, and a lot of the 
traditional ways we socialize involve food. Food is a big part of Delta 

Local favorites here are fried chicken, fried fish, fried potatoes and 
greens cooked with a hunk of fatback, all washed down with a tall glass of 
sweet tea, a beverage laced with enough sugar to make your ears ring. 

''There's an untold number of sugar grams in a glass of that tea,'' Nelson 

Changing entrenched habits -- getting patients to improve their diet, 
exercise, monitor their blood sugars and take their medicines -- is his 
toughest challenge, Nelson says. 

But it's doable. For Eddie Smith, a broad-shouldered man of 45 who was 
diagnosed with diabetes four years ago, managing the disease meant a 
lifestyle change for himself and his wife and three children, who now eat 

No more fried chicken, he says. Now it's baked. He acknowledges that ''I 
miss the old ways,'' but he says diabetes has an upside. Now, he walks 2 
miles a day with his wife and plays basketball at night with his son. He has 
dropped 40 pounds from his 225-pound frame, and he's ''feeling real good.'' 

Control is the key 

But the diagnosis of diabetes, and the knowledge of what he needed to do to 
get it under control, was depressing, says Smith, an assistant supervisor 
for the nearby city of Rosedale, where he lives. ''Once you learn about it, 
most people want to give up. It really brings you down,'' he says. 

Now, though, he has his diabetes under control. He takes a long-acting form 
of insulin once a day and regularly gets a hemoglobin A1C test that provides 
an indication of his blood sugar levels over the past three months. The 
test, which Nelson and other diabetes experts believe should become part of 
standard treatment, shows that Smith's blood sugar level is close to normal. 

That's something Smith wants to make sure other people with diabetes know. 
He says he has advised several friends to be checked for diabetes after they 
complained about feeling fatigued or overly thirsty, having to urinate 
frequently or having blurred vision. 

''People can live through diabetes if you treat it,'' he says. ''I started 
to listen to my doctor, and I'm getting my health back.'' 

Unfortunately, Nelson says, not all his patients are so successful. He 
describes one, a woman who is seriously overweight, whose chaotic family 
life, compounded by the stresses of poverty, is overwhelming. She can barely 
keep regular doctor's appointments, much less keep track of her blood sugar, 
medications and the other details of diabetes management. 

''One of the biggest issues we've had to handle is getting a patient to 
understand the consequences of their diabetes,'' he says. ''So many people 
come into the office, and as long as they feel fine, they don't care if 
their blood sugar is 300.'' (Normal is 70 to 110.) That's a problem for many 
diabetics. They feel OK until serious complications begin, and by then it 
can be too late to reverse them. 

If left unchecked, diabetes can lead to kidney failure, blindness, 
amputations and heart disease. 

Real help is available 

Local physicians are alarmed. Stacey Davidson, an ophthalmologist, says 
about 30% of his patients have diabetes-related eye problems, and Bennie 
Wright, a general surgeon, says fully half the operations he performs, such 
as bypass grafts and amputations, are to treat long-term complications of 

They say they're hoping a new project, the Delta Health Initiative, which is 
being launched by Delta State University and the University of Mississippi 
Medical Center, will help by creating a diabetes education and research 
center to pull educators, family physicians and medical specialists, 
dietitians and others together for a kind of one-stop medical approach to a 
complex problem. 

Despite the depth of the problem of diabetes here, Nelson and other experts 
are upbeat. New medications, greater use of the A1C test (which has been 
approved for over-the-counter sales as a home test kit) and a long-lasting 
form of insulin that cuts down on injections make treatment easier and more 

''It's important that diabetes patients realize the challenges of their 
illness,'' Nelson says. But ''it is critical for them not to be discouraged. 
Patients need to understand that if they take an active role in their 
disease, we have better ways to assess them and better tools than ever 

If the increase in diabetes had occurred 20 years ago, there would be little 
that doctors could do to help, Gavin says. Today, he says, what was once 
thought to be the inevitable outcome of diabetes is no longer that. 

''My great-grandmother died of diabetes. It was a time when if you developed 
'sugar,' you were going to lose your leg. It was not 'if,' just a matter of 

That's no longer true, and that positive change has occurred ''in my 
lifetime,'' Gavin says. ''If I live long enough, I may see a cure for this 
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