The Diabetes Belt

This part of the U.S. is the bull’s-eye in targeting type 2 diabetes
By Lindsey Wahowiak

Pat Higgins, who has type 2 diabetes and volunteers with the American Diabetes Association, has seen the diabetes population boom in Charlotte, N.C.

“In Charlotte alone, we have 165,000 people with diabetes,” she says, in a city of about 750,000. “In the community, to ‘have a little sugar,’ everybody considered that to be normal. That’s something you hear in the South in particular. I’m from the north [Chicago], and I didn’t hear that before.”

Charlotte is located on the edge of the “diabetes belt”—a geographic area of the United States where residents have a much higher risk of developing type 2 diabetes than people who live in other parts of the country. The ADA’s Charlotte office serves several counties in the belt. Within the diabetes belt, 11.7 percent of the population has diabetes—in some counties, that percentage can reach 13 percent. The national average is 8.5 percent.

The diabetes belt spans counties in most of the Southern states and reaches up through Appalachia. And, in general, it’s growing, according to the Centers for Disease Control and Prevention (CDC). New counties are added; we let out the belt another notch yet it cannot contain the strain. The geographic area affected closely mirrors the “stroke belt,” and its population generally is more prone to developing not only diabetes but also other chronic diseases.

Amit Vora, MD, FACE, is a professor of endocrinology at the University of Tennessee–Knoxville and a practicing endocrinologist. In his practice, he sees how some of the risk factors for type 2 diabetes culminate in a kind of perfect storm. Vora cites an unhealthy food culture, few convenient or safe places to exercise, and an impoverished and poorly educated population—and all too often, he sees complications in patients who didn’t get diabetes care early or regularly.

“I saw a patient who came in with an A1C of 13 [percent],” he remembers. “I said, ‘Had you not been feeling well?’ The patient said, ‘Doctor, I haven’t been to any doctor. I don’t like to do that unless something’s broken.’ People just don’t go to the doctor.”

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