80% of US diabetics are in 20% of America's zip codes

By Hops Latest Reply 2011-04-03 16:14:55 -0500
Started 2011-03-31 20:34:20 -0500

Eighty Percent of Diabetes Concentrated in 20 Percent of Zip Codes
Diabetes Health Staff
Mar 30, 2011
The recently launched U.S. Diabetes Index (USDI) has revealed that 80 percent of all diabetes cases are located in just 20 percent of zip codes. Dr. Gary Puckrein, USDI developer and CEO of the National Minority Quality Forum, hopes that the USDI will help the United States direct its resources to the most affected areas.

Why certain areas are most affected, Dr. Puckrein says, is a question that has no answer as yet. "The obvious response is obesity and lifestyle, but I'm not comfortable with answers like that. First of all, the underlying science is not there to make those kind of quick generalizations about why these populations are the way they are. The smart thing to do is to take a look at these communities in depth and try to get a better understanding of why the prevalence is the way it is, as opposed to giving snap answers that really have no basis in fact."

The USDI contains more than 30,000 maps, charts, and graphs depicting diabetes prevalence, costs, the uncontrolled and pre-diabetes populations, comorbid conditions, and other important indices. These are all segmented by geography down to the zip code level, and by age, gender, and ethnicity. According to the USDI, almost half of all patients with diabetes are not controlled; only 55 percent of them check their blood sugar at least once a day; and more than half report not visiting their doctor over a 12-month period.

Dr. Puckrein says, "We have to make a real commitment to secondary prevention. Right now, we're offering a diabetic about six to seven hours a year of professional care. There's really not a lot of reinforcement in the community to support the self management that we all say is required."

"What I would also argue very strongly is that we need better technology. The technology that we have to manage diabetes is inadequate. We are fooling ourselves. The disease is so difficult to manage that people aren't going to be able to manage it unless the technology is better. I don't know if you've ever read the guidelines for medical nutrition for diabetes, but they're a joke. Nobody in the world is going to do that, let alone read it and then implement it—that's not happening. We don't even understand the real difficulty involved in trying to do that. You're 65 years old and you sit down with a diabetes educator who starts telling you about counting carbs and this and that—these are not things that are easy to do."

"We've just got to get out of the habit of nice sound bites that everybody feels good about but that really don't address the underlying causes. The focus needs to be patient-centered. We need to understand where the patients are and get them to where they need to be, not simply tell them that they're misbehaving and don't know what they're doing."

Dr. Puckrein's colleague at USDI, Dr. Jaime Davidson, adds, " First of all, we cannot blame it on each other. It's time for all of us to work together, because if you're black or white, Asian, Latino, rich or poor, Democrat or Republican, you're going to develop diabetes. We are all Americans, and we need to work together to improve this problem, because it will be the biggest problem that we have in healthcare, and it's preventable. Everybody can contribute. This is not a time to trust Providence and do nothing."

"There are 26 million people with diabetes and two million new patients per year, and the potential complications are very costly. Each patient who goes blind will cost over $100,000 per year. Prevention is a lot cheaper, but nobody wants to pay for that today.
The lawmakers may be very happy at the end of this December, but the problem is that many of those lawmakers only see until December. They don't see the next year. We need to convince them that these people are not going to disappear. They're coming back, and they're going to bite you, and they're going to bite you big time."

26 replies

Dev 2011-04-02 19:24:14 -0500 Report

I just found this page on CDC website that describes the diabetic belt and how the counties were selected http://www.cdc.gov/diabetes/news/docs/diabete...

Some of you and also I had mentioned below that the prevalence might be because of the density of population in these areas. But as the above page explains 'Counties were placed in the diabetes belt if at least 11% of residents had been diagnosed with diabetes' and if they were adjucent to counties that had similar high prevalence.

So it is not total number of people but percentage of people in that county. There are two maps on the page as well that might interest you.

tabby9146 2011-04-02 12:18:49 -0500 Report

I know that the majority of the worst states for diabetes, meaning high rates, are Southern. I live in the South, the reason, is the way we cook down here! When I was growing up, there was lots of healthy food, unhealthy, and healthy that was fried. LOTS of fried food. In the summer, everyone put bacon grease in their fresh veggies, including my mother lots of times. It may not sound good, but believe me, it does taste good. When I got married, I did the same. I used to actually cook with Crisco shortening often! A few years later, I stopped that. I slowly began to bake more than fry, and not put the bacon grease in our food.
I made those changes long before I became diabetic. We also love our 'sweet' tea here, and Southerners drink lots of it. I did too. I stopped doing that just before I was diagnosed over 2 years ago. There is just so much fattening food.

Dbostrange 2011-04-01 11:20:05 -0500 Report

I would like to address Dr. James Davidson statement in the above article. How much research has been done to study Native Americans? This disease is rampant within the community? What is current research telling us about Cinnamon?

GabbyPA 2011-04-02 06:23:53 -0500 Report

I think they are looking in the wrong direction. I think it is more related to corn in the diets. When that is your main carb, there has to be some skew to it. But then again, white rice is a main carb in Asian societies, why don't they tend toward diabetes? There are so many things we can look at, and I think we have to start broadening our boxes a bit and look at things we might not ordinarily consider. Even weather and temperatures of where we live. Does it all affect our bodies is ways we just don't know yet?

Dev 2011-04-02 11:17:46 -0500 Report

One of Parag's doctors (an endo) said that in her observations of her patients, the Asians who came to US whose diets changed dramatically, especially the bread becoming major part triggered onset.

Something about being used to certain ingredients or food in the diet and when that changes even if it is a carb to carb switch it affects differently. I thought it was an interesting observation about how traditional diets affect that group differently than how it affects other groups.

Also, I can relate with you about thinking about aspects like weather, temperature and where we live. In Ayurved, the traditional medical system of India, when they prescribe or think about diet it comes with a whole package of 'all things consumed' - meaning all things you eat, the geographical location (near sea, plateau, plains etc.), the overall weather, season, movements (overall daily behaviours), and interactions with others (humans, and nature).
It is quite an interesting way of looking at health and what affects it.

GabbyPA 2011-04-03 16:14:55 -0500 Report

That is an interesting concept. But it is so more true. We try so hard to fit everyone in a box and forget all the things around them that are contributing factors.

kdroberts 2011-04-01 11:47:36 -0500 Report

Most current research is telling us cinnamon doesn't really do anything to treat any medical conditions, at least for the general population. Some people see some positive things when taking it but not enough for it to be considered anything more than a statistical anomaly.

The USDI that is referenced in the article is actually a project of the National Minority Quality Forum and contains a lot of info about Native Americans. It's only a few weeks or so old so hasn't been fully utilized but one of the perceived uses of it is statistical analysis of different populations and then targeted studies to see why certain areas or cultures suffer higher rates of diabetes than others.

Hops 2011-04-02 06:14:21 -0500 Report

The nation of Finland has the highest rate of diabetes of any nation in the world. Theories abound as to why. Lack of exposure to vitamin d is one theory.

Dbostrange 2011-04-01 14:11:28 -0500 Report

Here is an interesting fact. The cinnamon information was given to me by the tribal health clinic. Native American's have traditionally used plants/herbs for medicinal cures. At present I am using Cinnamon in my diet based on that recomendation.

Nonna2Three 2011-04-01 08:08:32 -0500 Report

There is an article in the News section that lists states:


dietcherry 2011-04-01 11:03:40 -0500 Report

I would be curious to see the statistics for prevalence of T1 in the country's areas/zip codes. It doesnt appear that this particular study separated cases of T1 from T2. I had already heard about the "diabetes belt" cutting a swath through the Southeast but without the distinction between the 2 diseases, how is it ultimately helpful to gaining a sense of pattern, if one exists, with T1? Just thinking it may offer clues about the development of T1 since we really dont know alot about the causes.

kdroberts 2011-04-01 07:46:37 -0500 Report

On face value it doesn't seem like much of a shocker and possibly it may be a completely pointless study. When you look at ZIP code locations there are a lot where there are only a few houses and a lot that are pretty much industrial buildings where no-body lives. Then you look at the flip side and you have the highly densely populated ones. Just on a really small scale if you take 2 ZIP code regions, one that has 10 people living there and the other having 10,000 living there, it would stand to reason that the one with the most people would contribute more diabetics than the the other.

I think the USDI can provide some really good information, I don't know if this part fits that. It would be more interesting to see the % of each ZIP code population who has diabetes.

GabbyPA 2011-04-02 06:19:43 -0500 Report

I guess not so much because of the actual city, but general demographics of those zips. Like is the south really plagued or is it out west in the states where the native American's reside. I was more curious about that kind of thing and like he mentioned, those in big cities where fast food is main fare.

dietcherry 2011-04-02 08:38:25 -0500 Report

Gabby, my state, North Carolina, has the 3rd largest nationwide population of Native Americans (141,321), led by Oklahoma (179,524) and New Mexico (163,907). Its long been suggested that the typical Southern diet of high-fat and fried foods and sedentary lifestyles directly contribute to prevailing rates of T2 diabetes.

tabby9146 2011-04-02 12:24:29 -0500 Report

I responded before reading your reply and that is exactly how I feel too, having grown up in the South, I know how most of us eat, or how I used to eat. There are more overweight people here I think too because of that, and most people that I know, and those I have known all of my ilfe, do not exercise. most people I know continue to eat the same way, and don't make changes. Things are deep fried, so much sugar it is unreal. My mother may not have realized when I was growing up (skinny kid, always ) how bad sugar was. We had lots of fresh fruit and vegetables, but we also had lots of sweets, every single day I had something sweet as a snack, whther it was cookies, chips, whatever. So I grew up 'addicted' to sugar like most everyone else, and there is no doubt in my mind that it led to this. once you have had it your whole life, it is the hardest thing in the world to change. Also, the states where the majority of people don't have the money to buy healthy as often as they should, so the cheaper unhealthy foods they eat.

Hops 2011-04-02 10:25:30 -0500 Report

The bio diversity specialist Gary Nabhan wrote about the high rate of diabetes among Native Americans in Arizona where he teaches. He found
that Native American cooking traditions have been ignored while fast food has gained popularity. Nabhan noted that a century ago there was a small
amount of diabetes among Native Americans in Arizona.

Hops 2011-04-02 07:59:55 -0500 Report

I visited the US Diabetes Index site hoping to gain such info. One must subscribe to USDI to get access to their maps. Will leave a message with the USDI director to see if they will accept me as a subscriber and at what cost.

Dev 2011-04-01 17:42:30 -0500 Report

Yes, I was thinking about the same thing. The statistics needs to be shared as ratio of diabetics per total population in that zip code. Statistics can be so deceptive if used without context.

Also I wonder if the numbers can get skewed if a state, city has better early detection services. These areas might show on paper that they have more people with diabetes while other zip codes might have people with diabetes that are not diagnosed due to poor health care so look as if they have less prevalence. Again deceptive.

BandonBob 2011-04-01 10:50:27 -0500 Report

I have to agree. It stands to reason that there are more diabetics in a city like New Tork than there would be in the entire state of Oregon. After all, New York City alone has twice the number of people. This is one of those that makes me just say "Duh!"

GabbyPA 2011-04-01 06:30:56 -0500 Report

Does this study list the zip codes that are "diabetic"? That would be very interesting to see how geography plays in it. How even local EPA violations or vaccine ratios play in it all. There are so many theories out there. It would be interesting to see what is going on.

Hops 2011-04-01 09:39:22 -0500 Report

The study is a beginning toward understanding which areas are most impacted by diabetes. It is remarkable that 50% of diabetics in the study are
not controlled diabetics. My reading is that USDI is using this study to determine where and why diabetes is the most severe. I question the one doctor who claims that the average diabetic receives six hours of professional medical care and advice a year. In my life I get about one hour of professional care and advice a year.
My guess would be regions with a high percentage of fast food restaurants will be among those where diabetes is concentrated. The NIH already knows there is a predominance of diabetes in southern states.