WSU study triggers rural campaign to fight diabetes - Spokane, North Idaho News & Weather

WSU study triggers rural campaign to fight diabetes

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Research found 10 small towns east of Cascades to be hot spots for disease

By Mike McLean
Of the Journal of Business

A Washington State University research project that identified communities with high rates of diabetes-related disease has led the Eastern Washington Diabetes Network to put more focus on its diabetes awareness and education efforts toward residents and health-care providers in rural areas.

The recently released study, titled Identifying Diabetes Hot Spots in Washington State and Taking Action, pinpointed 39 communities across the state, including 10 communities in Eastern Washington, with higher-than-expected diabetes-related disease among middle-aged and older adults.

The hot spots include the Eastern Washington communities of Mead, Medical Lake, Spangle, Addy, Northport, Dayton, Lind, Edwall, Inchelium, and Odessa.

Kenn Daratha, assistant professor of informatics at Washington State University at Spokane, and Jennifer Polello, health education manager with Spokane-based Inland Northwest Health Services, analyzed U.S. Census and health data from 563 Washington communities to identify towns that need improved diabetes awareness and education efforts.

 Diabetes "is a big and growing problem in Washington," Daratha says. "And it's a rural problem in our part of the state. We're trying to use this data to help build a coordinated response."

To increase its diabetes awareness and education efforts, the network is attempting to provide in rural areas more opportunities for screenings, such as those recently held at some Rosauers and Safeway stores in the Spokane area, and more interaction between network participants and rural health-care providers.

In the Puget Sound region of Western Washington, 11 of 13 hot spots were identified in urban areas, including the inner-city areas of Seattle and Tacoma. The remaining hot spots were 13 rural communities in coastal and Central Washington and three urban communities in southwest Washington.

The bodies of people who have diabetes don't produce or properly use insulin, a hormone needed to convert sugar and other food into energy. Genetics and environmental factors, such as obesity and lack of exercise, play roles in the onset of Type 2 diabetes, also known as adult-onset diabetes.

Complications of the disease include increased risk for cardiovascular disease, microvascular disease leading to blindness, kidney failure, and circulation and nerve damage that can result in amputations of extremities.

Daratha and Polello presented their findings in March at the Northwest Regional Rural Health Conference, held in Spokane Valley.

Even before the study was complete, Polello says the preliminary data in the study caused the Eastern Washington Diabetes Network, which until last summer was called the Spokane Area Diabetes Group, to alter the focus of its efforts.

"We decided we needed to change our borders to include 10 counties in Eastern Washington," says Polello, chairwoman of the network.

The network is made up of 90 members, including researchers, clinicians, disease managers, health administrators, educators, and public health and social service workers. Its goals are to increase awareness of diabetes, promote strategies for control and prevention of the disease, and strengthen the network of professionals who provide education and care for diabetes patients.

"We can ask everyone to watch their risk factors," Daratha says. "Everybody should know their cholesterol levels, blood lipids, and blood pressure."

Polello says people with diabetes and their health-care providers need to have knowledge and tools to control the disease and to minimize risk factors. Often, complications can be are prevented if the disease is addressed early through diet, exercise, and medications.

"You can't take a vacation from diabetes," she says. "If people manage it on a daily basis, they are most likely not going to see complications of diabetes."

The network's partners are working with rural health-care providers to make sure they understand the standards for diabetes care recommended by the American Diabetes Association.

"Under 10 percent of people with diabetes are receiving the screenings recommended in the standards of care," Daratha says.

The standards include regular blood tests, eye exams, foot exams, and monitoring of blood pressure, cholesterol, weight, and diet.

"What happens is people (in the hot spots) don't receive routine prevention. Then, when they get really sick, they end up in Spokane hospitals."

Some physicians in rural communities know about the need to reduce risk factors for diabetes, but the growing prevalence of diabetes can be overwhelming, Daratha says. Nearly 15 million Americans have been diagnosed with diabetes, and the national Centers for Disease Control (CDC) estimates that one in three Americans born since the year 2000 will develop diabetes in their lifetime.

 "It's very common for a community to have only one physician," he says. "Some rural communities don't have a physician. We've got to find a way to get them services."

 In the study, each community designated as a diabetes hot spot was higher than the state average in six criteria.

One criterion was the prevalence of people between the ages of 45 and 74 in a community's population. People in that age group are most at risk of contracting adult-onset diabetes. In the 10 Eastern Washington hot spots, 33 percent of the population is in that age group, compared with 28 percent statewide.

Another criterion was the prevalence of people in that age group diagnosed with diabetes. In the Eastern Washington hot spots, 17 percent of the population between the ages of 45 and 74, had been diagnosed with the disease, compared with 8.6 percent of that age group statewide.

A third criterion was the rate of hospital discharges of patients who have been treated for diabetes. In the 10 hot spots, the rate was 317 discharges per 1,000 people in the general population over a 10-year period, compared with a rate of 235 per 1,000 over 10 years for the entire state.

The three remaining criteria were the prevalence of people treated for specific types of damage to the kidneys, the eyes, and the nerves, each of which is a complication of diabetes. For each of those complications, the rate in the Eastern Washington hot spots was three to four times that of the entire state.

The population of Spokane was within state averages for all of the criteria.

"Spokane has terrific endocrinologists and other professionals taking care of patients," Daratha says. "This analysis is of particular concern to rural communities with restricted access to health-care services. As the prevalence of this disease increases and the rate of compliance to care standards remains low, increases in diabetic complications and costs are inevitable."

The network recently completed a five-month public-awareness campaign about diabetes, targeted at rural areas in Eastern Washington and done in partnership with KHQ-TV, and is compiling a survey to determine whether that campaign increased diabetes awareness and altered behavior in the target areas. Daratha says the results of the survey will be analyzed in coming months.

"If we find the media campaign is effective, we will try it again," he says. "If it's not effective, we'll adjust our efforts."

Public health issues rarely change quickly, he says.

"For the Eastern Washington Diabetes Network, it's an ongoing concern to find a way to work with rural partners," he says." We don't picture our work will ever be done."

Washington state has a higher prevalence of diagnosed cases of diabetes than the nation. As of 2004, Washington state had a diagnosed diabetes rate among adults of 6.1 percent of the population, up from 3.4 percent 10 years earlier, according to the CDC. The national rate for diagnosed diabetes in adults was 5.1 percent in 2004, up from 3.2 percent in 1994.

Many diabetics aren't diagnosed with the disease until complications occur, Daratha says, and the CDC has determined that a third of the people with diabetes don't know they have it.

Polello says, "Diabetes is everybody's problem. Everybody knows somebody who's affected."

The Eastern Washington Diabetes Network's goal is to increase public awareness about prevention and control of diabetes.