‘Diabetes belt’ identified in southern US

Issue: April 2011

Researchers have identified a “diabetes belt,” a cluster of 644 counties in 15 mostly southeastern states that have a prevalence of diabetes of 11% or more.

The belt includes portions of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, West Virginia, and the entire state of Mississippi.

Using data from the 2007 and 2008 Behavioral Risk Factor Surveillance System and county-level diagnosed diabetes prevalence estimates, researchers found that the prevalence of diabetes in the diabetes belt was 11.7% vs. 8.5% in the rest of the country.

“Nearly one-third of the difference in diabetes prevalence between the diabetes belt and the rest of the United States is associated with sedentary lifestyle and obesity,” researchers wrote in the American Journal of Preventive Medicine.

When researchers compared demographics and risk factors such as age, sex, sedentary lifestyle, race/ethnicity, education and obesity, four factors distinguished the diabetes belt from the rest of the United States:

Diabetes belt counties contained substantially more non-Hispanic blacks (23.8% vs. 8.6%).
Obesity was greater in the diabetes belt (32.9% vs. 26.1%).
Sedentary lifestyle was more common (30.6% vs. 24.8%).
The proportion of people with a college degree was smaller in the diabetes belt (24.1% vs. 34.3%).

Additionally, 30% of the excess diabetes risk in the diabetes belt was associated with modifiable risk factors, whereas 37% was associated with nonmodifiable factors such as age and race/ethnicity.

Culturally appropriate interventions

Tailored interventions that target obese, sedentary, non-Hispanic black people should be considered in appropriate locations within the diabetes belt, the researchers said.

“Identifying a diabetes belt by counties allows community leaders to identify regions most in need of efforts to prevent type 2 diabetes and to manage existing cases of the disease,” Lawrence E. Barker, PhD, from the division of diabetes translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, said in a press release. “Although many risk factors for type 2 diabetes can’t be changed, others can. Community design that promotes physical activity, along with improved access to healthy food, can encourage the healthy lifestyle changes that reduce the risk of developing type 2 diabetes.”

Comparisons with the ‘stroke belt’

In the 1960s, a group of US states with high age-adjusted stroke mortality defined a “stroke belt;” the belt included Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia. Until recently, geographic patterns of diabetes had not been specifically characterized in the same manner, according to background information in the study.

However, as was seen with the stroke belt, counties may move in and move out from a specific belt. This may also be the case with the diabetes belt, the researchers said, as diabetes prevalence can change with time.

For more information:

Barker LE. Am J Prev Med. 2011;doi:10.1016/j.amepre.2010.12.019.

Once again the South 'rules' as far as diabetes is concerned. This reflects the increased number of minorities as well as the high prevalence of obesity in these states. Controlling the epidemic of type 2 diabetes cannot be achieved by an individual physician, so government intervention in the prevention of diabetes is necessary. This is even more important since we have recently learned that having diabetes results in a 6-year reduction in life expectancy - comparable to smoking, which reduces life expectancy by 7 years.

– David S.H. Bell, MD,
Endocrine Today Editorial Board member

Disclosure: Dr. Bell reports no relevant financial disclosures.

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