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Diabetes in Central Ohio

Diabetes in Central Ohio: A Problem We Can't Afford to Ignore
Is it Getting Better or Worse?

What are the Numbers

According to the Centers for Disease Control, the national incidence of diabetes has increased 33% in the last eight years. In Central Ohio, the numbers continue to grow. By the end of 2001, there will be 171,500 people with diabetes, as compared to 158,500 two years ago. According to the 2000 Columbus and Franklin County Community Health Risk Assessment, 6% of adults have been diagnosed with diabetes. Of those, 47% were diagnosed between the ages of 45 to 64; 19% were 35 to 44; and, 18% were age 34 and under when diagnosed.

New Data

One of the two major findings of Diabetes in Central Ohio: A Problem We Can't Afford To Ignore focused on diabetes mortality rates in Columbus. The report relied primarily on the Columbus Health Department's (CHD) 1994 Mortality Assessment for age-adjusted mortality rates by race and gender. The following information is based on analysis of the 1990 to 1998 mortality data by the Columbus Health Department (presented in 2000), which provides a comparison between 1994 and 1998 numbers.

What's Changed?

Columbus' diabetes mortality rate increased 29% from 20.8 deaths per 100,000 people to 26.8 deaths per 100,000 people, and continues to be twice the national mortality rate of 13.6 deaths per 100,000 people.

There are notable increases across the board in diabetes mortality rates by race and sex from 1994 to 1998:

  • Black Males: INCREASED 8 % from 44.4 to 48 deaths per 100,000 people
  • Black Females: INCREASED 44 % from 26 to 37.5 deaths per 100,000 people
  • White Males: INCREASED 26 % from 22.6 to 28.4 deaths per 100,000 people
  • White Females: INCREASED 32 % from 15.7 to 20.7 deaths per 100,000 people

Budget Restraints: Despite endorsement by 170 community health-care professionals, $279,000 earmarked by the Columbus Health Department for funding to address chronic disease was eliminated from the city of Columbus' 2001 budget.

Funding Priorities and Competing Needs: Many traditional and new funding sources are heavily focused on the development of new and innovative programming approaches (rather than on sustaining current programs and services), and on community planning and training efforts. While these efforts contribute to the development of future programs, there is a lack of funding for direct services to address the current need for diabetes detection and self-management education.

Reductions/Shortages
Local hospitals continue to reduce or eliminate outpatient diabetes-education programs due to cost-constraints.

There is a shortage of primary health-care providers willing or able to provide health-care services to low-income and uninsured persons. Those who do, including free clinics and the Columbus Neighborhood Health Centers, report lengthy waiting lists for new patients and are at or near capacity. Programs that provide diabetes medications and supplies are severely limited.

Central Ohio Diabetes Association's expanded programming initiated in 2000 is jeopardized by a lack of funding for continuing services.

What About the Community Diabetes Task Force?

The Community Diabetes Task Force which was recommended in Diabetes in Central Ohio: A Problem We Can't Afford to Ignore was initiated and co-led by Central Ohio Diabetes Association and the Columbus Health Department. Their goal was to "enhance efforts to stress the importance of early detection of diabetes, and remove barriers to the treatment and care of individuals living with and/or impacted by diabetes." The task force met several times in the past year and focused on identifying service partnerships and state-of-the-art programs related to diabetes prevention, detection and education.

What Does It Mean?

Diabetes continues to be a growing and serious threat to Central Ohio. Columbus' diabetes mortality rate is twice that of the nation. It is 29% higher in 1998 than in 1994, and has increased an average of 6% each year since 1990. It is apparent there is an ever-growing crisis related to diabetes in Central Ohio. Additionally, the data reflect a serious disparity in mortality rates for African Americans with diabetes. This disparity is revealed in the alarming increase in African-American female mortality rates as well as the mortality rate for African-American males. In fact, the mortality rate for African-American men continues to be highest among the groups studied and is three-and-a-half times the national rate for the general population.

There is genuine concern regarding diabetes and its impact on our community. However, community resources continue to be severely limited due to a lack of funding in Central Ohio for outreach and direct services that are needed to help people effectively manage their diabetes and prevent the complications that contribute to high mortality rates. Factors impacting funding of direct services include:


Diabetes in Central Ohio: A Problem We Can't Afford to Ignore, released in February 2000, revealed several major findings:

  • Central Ohio's diabetes mortality rate is nearly twice the national rate;
  • Columbus's African-American population has alarmingly high rates of mortality due to diabetes, particularly among Central Ohio black men, where the death rate due to diabetes complications is four times the national rate; and,
  • Complications have already developed in more than half of local people who are diagnosed with and/or are in treatment for diabetes.

The study also exposed seven underlying reasons for higher rates of death and complications in Central Ohio. They include:

  1. the inability to afford medication
  2. a lack of insurance coverage for supplies, which discourages proper monitoring of blood-sugar levels;
  3. the inability to get foods required to meet diet guidelines;
  4. insufficient diet instruction;
  5. a lack of exercise, often due to other health conditions;
  6. a lack of understanding of the urgency and benefits of diabetes control and available resources; and,
  7. poor access to services and/or transportation.

Copyright 2000, 2001. All Rights Reserved. Central Ohio Diabetes Association . Columbus, Ohio.

Funding Crisis Threatens Resources

Recommendations

  • Centralized leadership is needed to coordinate the numerous diabetes task forces and planning efforts underway in the community. These task forces compete for funds and community participants.
  • A system of sustained funding is needed to support diabetes education programming. Funding should build upon current diabetes community resources rather than continually starting over with new initiatives.

Next Steps

  • Coordinate an inventory of community diabetes services to enhance partnership opportunities using a service matrix developed by the Columbus Health Department.
  • Convene a summit meeting of the leadership of community tasks forces currently focused on health issues and diabetes to identify gaps in service, to coordinate efforts and to advocate for funding.

Why is direct service funding so crucial?

In some medical fields the literature about treatment varies a great deal--in diabetes, however, the research is consistent and clear. A daily self-management regime that balances medications, diet, exercise and testing of blood sugars leads to tight control of diabetes, which prevents diabetes complications by up to 76%, and subsequently saves lives. Education, guidance from a team of health-care professionals and psycho-social support are crucial to effect the long-term behavioral changes that lead to tight control. According to the 2001 Franklin County/Columbus Health Risk Assessment, 28% of people with diabetes do not monitor their blood glucose levels at all; when asked how often they saw a health-care professional, 33% with diabetes indicated not at all.

In addition to saving lives, new research shows that diabetes education can also save dollars. While it has long been recognized that diabetes education saves health-care dollars in the long-term, short-term cost savings are now documented. A study released in January, 2001, in the Journal of the American Medical Association concluded that sustained reductions in blood glucose levels among patients with diabetes are followed by significant reductions in health-care utilization and costs within one to two years (estimated annual cost reduction of $900 per patient).

Is There Any Good News?

The best news continues to be that research proves that diabetes complications and mortality can be prevented through early detection and diabetes self-management education.

Diabetes has been identified locally by community leaders and health care professionals as a public health issue of great concern. There are numerous community efforts underway to explore and address the problem of diabetes in Central Ohio and to determine interventions to reduce diabetes-related death and complications. The challenge now is to ensure that these efforts result in more services to help people with diabetes.

Diabetes is gaining stature on a national level as a serious health concern of epidemic proportions. One symbol of that is the recently issued Diabetes Awareness Commemorative Stamp by the U.S. Postal Service, whereby diabetes joins the rank of diseases such as AIDS and breast cancer. With those diseases, social awareness has led to improved funding for research and services.

There is strong momentum in the 124th Ohio General Assembly towards passage of the Diabetes Cost Reduction Bill (House Bill 100 and Senate Bill 45), which would guarantee coverage of diabetes medication, supplies and education. By improving access to medications and guaranteeing coverage of testing supplies and diabetes self-management education, this bill would address three of the seven underlying reasons for higher rates of diabetes complications and mortality in Central Ohio.

What Can Be Done?

The diabetes mortality rate in Columbus and Central Ohio continues to increase, as does the number of people diagnosed with diabetes. There is a critical need for funding for programs to:

  • prevent and detect diabetes;
  • teach diabetes self-management skills
  • link individuals to community resources; and,
  • increase public awareness as to the urgency of diabetes control, the need to be tested and the community resources that are available.

Funds are also needed to expand primary health care services to ensure the availability of medical care for low-income and uninsured people with diabetes.

This piece is intended as a supplement to the original study. Please see the summary of highlights or the full report for information on the objectives and findings of the study and for a research review.