Thursday, May 24, 2018
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Breaking the grip of the ‘diabetes belt’


Tom Pfau of Sylvania walks at Olander Park. He exercises daily to keep his Type 2 diabetes under control.

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When Sylvania resident Tom Pfau was diagnosed with Type 2 diabetes during a routine doctor’s checkup more than eight years ago, he met the disease face-to-face and decided he would do what he could to maintain the upper hand.

"Being diagnosed with a disease that will require care and monitoring for the rest of your life is the down side," said Mr. Pfau, an engineer at Ghafari Associates in Dearborn, Mich.

How could there be an upside to learning that you’re one of a growing number of Americans with Type 2 diabetes?

"I was glad there was a place I could go to get more information and understand what I’d be going through," he said. "That was the good side. I didn’t have to go to the Internet. But I could speak with others and see others involved in that experience."

Every hospital and hospital system in the Toledo area has a diabetes care center and regularly offers courses or classes on the disease.

It’s no wonder.

The Centers for Disease Control and Prevention data show that 33,890 adults, 10.7 percent of the adults in Lucas County, were diabetic in 2008. In Wood County that same year, 8,923 adults — 9.7 percent — were diabetic.

‘Diabetes belt’

The National Diabetes Information Clearinghouse Web site explains the difference in Type 1 and Type 2 diabetes this way: Type 1, once labeled juvenile or insulin-dependent diabetes, is diagnosed in children, teens, or young adults whose pancreas no longer makes insulin. Type 2 diabetes, once described as adult-onset or noninsulin-dependent diabetes, can develop at any age, including during childhood. Overweight and obese persons who are sedentary have an increased chance of developing diabetes.

Mr. Pfau’s experience is shared by nearly 26 million Americans, according to the American Diabetes Association. That figure includes 10 million more Type 2 diabetics who have been diagnosed with the disease in the last 20 years.

Early in March, federal researchers said a "diabetes belt" has formed across the southeastern region of the country. CDC research shows high rates of diabetes in 644 counties in 15 states, including Ohio, Pennsylvania, Kentucky, and West Virginia. Nearly 12 percent of the residents in those counties have diabetes, compared to 8.5 percent in the rest of the nation.

Though more people over age 65 and a large number of African-Americans live in those regions, the report indicates that even people who are not overweight but who live in those areas are more likely to be diagnosed with diabetes than their slim counterparts outside the diabetes belt. Moreover, people in the diabetes belt with the disease are described as African-American, obese, having a sedentary lifestyle, and fewer college degrees.


Diabetes is not only expensive to treat — about $100 billion a year — but it demands constant attention from its patients. To keep it under control requires "a complete lifestyle transformation," said Dr. Mark Watkins, a ProMedica pediatric endocrinologist.

"It is essentially all-consuming because the diabetes is not taking a break and diabetics can’t take a break," he said. "So with each meal, with each food item, each snack, and each beverage they drink, somewhere in the back of their minds they must think about, ‘How will this affect my blood sugar?’ "

The results of another study by the Emerging Risk Factors Collaboration at the University of Cambridge in England suggest that not every diabetic is diligent about management.

That research, published in March in the New England Journal of Medicine, showed that Type 2 diabetics at age 50 face a loss of six years of life compared to the average. While a person’s blood glucose levels must be consistently very high in order to die only from diabetes, high levels of glucose in the blood adversely affect the organs and pose other problems that can lead to death.

Diabetics face an increased risk of death from cardiovascular, kidney, liver, chronic obstructive pulmonary, and infectious diseases, various cancers (liver, pancreas, ovary, colon and rectum, lung, bladder, and breast cancers), pneumonia, falls, mental disorders, and an increase in intentional self-harm.

Taking control

Some diabetics, however, are proactive about maintaining control of their blood sugar.

Mr. Pfau, for example, has curbed some previous habits, such as his consumption of fried foods and alcoholic beverages. The sum total of his exercise routine once was to mow his lawn every week.

That has drastically changed. In the more than 3,000 days since his diagnosis, Mr. Pfau — who is in his early 60s — has walked three-and-a-half miles every day, either on his treadmill or on an outside trail. His total so far is more than 10,000 miles.

"There are people who decide to take the bull by the horns, so to speak," Dr. Watkins said. "They don’t enjoy it, but they do it."

Taking control includes more than checking blood sugar levels daily, frequent doctor’s visits, annual eye examinations, regular dentist’s appointments and blood pressure checks, eating the right foods, and exercising. It also involves using what health professionals describe as a common-sense approach to other aspects of health: always wearing shoes, having one’s feet examined by the doctor during each of those visits, taking medication at the same time daily, and having one’s A1C levels checked twice a year. An A1C test gives a summary of blood sugar levels over three or four months.

Jane Graffin, dietician and certified diabetes educator at Wood County Hospital, said some people who cannot afford the medication are forced to choose between it and other necessities, which leads to poor diabetes control and risks for complications.

Education important

Unfortunately, some diabetics view the illness as a condition rather than a disease, observed Dr. David Kendall, chief scientific and medical officer of the American Diabetes Association. That’s why diabetic patients need to be taught about the disease. Ms. Graffin said doctors cannot simply issue a patient a diagnosis of diabetes and prescriptions to control it, and send them home.

However, some patients have trouble paying for diabetes education because they cannot afford it on their own or because their health insurance won’t pay for it. Ohio is only one of four states that does not require health insurers to cover diabetes education. Under Gov. John Kasich’s administration, Ms. Graffin has little hope that the Diabetes Cost Reduction Act will pass.

"It’s a real challenge when people in Ohio don’t have that right or privilege" to access diabetes education classes, she said. "I can’t tell you how many clients call and want to be scheduled for diabetes education and they cancel because they don’t have the insurance or the money for the classes."

Megan Kaun, a clinical assistant professor in the University of Toledo College of Pharmacy and Pharmaceutical Sciences, said that 80 million Americans are estimated to have pre-diabetes. That means their blood glucose levels are high, but not high enough for them to be labeled diabetic. Unfortunately, the epidemic of obesity among young people also puts more of them at risk for the disease. Consequently, they will have it longer and face more risks.

Dr. Veronica Jean-Pierre, an adult endocrinologist at Mercy St. Vincent Medical Center, said that the increase in the number of people diagnosed with diabetes is partly due to more people asking to be screened.


Medical professionals are increasingly concerned about the growing rate of obesity among young Americans.

"Kids in elementary schools are obese before they get into high school," Dr. Jean-Pierre said. "We figure that people have diabetes at least a couple of years before they are diagnosed, and the longer you have diabetes, the greater the complications."

Ms. Kaun takes note of Toledo Public Schools’ plan to slash physical education from elementary and junior high schools. That’s especially worrisome when data show that the rate of diabetes in Lucas County is worse than that in other Ohio counties.

She said that 70 percent of the adults in Lucas County are overweight or obese, and that deaths related to diabetes in Lucas County are higher than in the rest of the state. For example, 42 percent of the males die from diabetic-related causes in Lucas County compared to 35 percent for the rest of Ohio.

She also said that from 2003 to 2005, according to the most recent figures available, diabetes was the fifth leading cause of death in Lucas County. Additionally, the number of overweight children ages 6 to 11 has quadrupled and the rate of obesity in the 12-to-19 age group has jumped 2.5 times, she added.

Health professionals say that though medicine to treat diabetes has advanced, the direct correlation between Type 2 diabetes and obesity involves lifestyle.

"Without a change in lifestyle and behavior, the likelihood of halting that disease and it not getting any worse is almost nonexistent," Ms. Kaun said.

Contact Rose Russell at
or 419-724-6178.

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