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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.
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
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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