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Living at an Epicenter of Diabetes, Defiance and Despair - New York Times
In the Treatment of Diabetes, Success Often Does Not Pay
Experts
say they do not know whether efforts to prevent diabetes have finally
started to work, or if the disease has simply peaked in the population.
But they say the shift tracks with the nascent progress that has been
reported recently in the health of Americans.
There is growing evidence that eating habits, after decades of deterioration, have finally begun to improve. The amount of soda Americans drink has declined by about a quarter since the late 1990s, and the average number of daily calories children and adults consume also has fallen. Physical activity has started to rise, and once-surging rates of obesity, a major driver of Type 2 diabetes, the most common form of the disease, have flattened. Type 1 diabetes, often diagnosed in childhood and adolescence and not usually associated with excess body weight, was also included in the data.
Experts cautioned that the portion of Americans with diabetes was still more than double what it was in the early 1990s.
They said progress had been uneven. Educated Americans have seen
improvements, for example, while the rates for the less educated have
flattened but not declined. The number of new cases is dropping for
whites, the 2014 data show, but the change has not been statistically significant for blacks or Hispanics, though both show a downward trend.
Still,
the shift represents a profound change in one of the most vexing health
problems in the United States. Diabetes afflicts one in every 10
American adults and is the country’s leading cause of blindness, limb amputations and kidney dialysis.
“It’s
not yet time to have a parade,” said Dr. David M. Nathan, the director
of the Diabetes Center and Clinical Research Center at Massachusetts
General Hospital. But he noted, “It has finally entered into the
consciousness of our population that the sedentary lifestyle is a real
problem, that increased body weight is a real problem.”
Even here in Alabama, which has the highest prevalence of diabetes in the country,
the rate of new cases has begun to taper. According to figures for
2013, the most recent available by state, 12.7 percent of Alabama’s
residents had the disease.
In
the tiny town of Eutaw, Lynette Carpenter got serious about staving off
diabetes around the time her cousin’s leg was amputated because of the
disease. She started to make a dish she called Sexy Pork Chops,
involving a bell pepper, an onion and the oven. She weaned herself off
Coca-Cola, going from about 50 cans a week to fewer than seven. And she
started walking, leaving rubber bands in her mailbox to pull onto her
arm — one for each mile walked — to remind her how many miles she had
gone. The result made her doctor proud: She lost 42 pounds, and two
years later has still not developed full-blown diabetes.
Diabetes “has got my respect and attention,” she said. “I take it real serious.”
Robin
Williams, a music teacher in Birmingham, lost 33 pounds by cutting out
candy, packing her lunch and not buying fast food during long bus trips
to band practice, habits she learned in a Y.M.C.A. program on diabetes prevention.
She started watching “My 600-lb Life,” a television show about people
losing weight, with her teenage daughter. The show frightened her, as
did her father’s leg amputations two years ago. She is down to 222
pounds, and is determined to keep going.
“I
want to see my child grow up,” Ms. Williams said. She uses an app on
her phone to track her calories. “It made me much more conscious of what
I was putting in my mouth.”
Diabetes
has been particularly devastating here in what is known as the Black
Belt, a strip of counties that originally got its name for its fertile
soil. Its majority black populations were once slaves, and later, after
the Civil War, they were sharecroppers. The area had some of the worst racial violence of the Jim Crow era,
said Hasan Kwame Jeffries, an associate professor of history at Ohio
State University, and today is among the poorest in the country.
“Black
folk in the Black Belt have never not been living in poverty,”
Professor Jeffries said. “It’s not a cycle, it’s linear. It’s an
unbroken line from slavery forward. And it’s really critical for
understanding why there’s such a health crisis in these counties.”
Ethel
Johnson, a nurse in Camden, a little town in Wilcox County, said
diagnoses were coming so thick and fast in the 1990s that many people
thought something had been added to the water.
“Diabetes
was coming up everywhere — among friends, family, church members,” she
said in her small office adorned with posters of fruit and vegetables
and one of the Rev. Dr. Martin Luther King Jr.
Amputations
became common. Eleanor Randolph, a retired schoolteacher in Livingston,
said her cousin last year lost a toe and then, a few months later, a
leg. He recently lost the other leg.
“It kind of shakes you up,” she said. “It makes you think. It makes you want to do right.”
Bernice
Wright, 40, a driver of a medical van, said several patients had lost
so many of their limbs that they could no longer move without being
lifted.
“It’s like a shark did that to their body,” she said.
But
that devastation, deeply frightening, is also inspiring change. Pamela
Moton, 30, a resident of Pine Apple, cut a pink streak down a leafy
trail on a recent morning, power walking in yoga pants and a fuchsia top
to escape her genes, her culture and her history.
Her
father, now dead, had diabetes, and so did an aunt. Her mother, who
weighs over 350 pounds and had a heart attack in her 50s, does not move
around much anymore because of her weight.
“That just like motivated me,” she said. “I thought: ‘I can’t get like that.’ No way can I get like that.”
Some
say prevention programs have helped keep them on track. Ms. Carpenter,
the woman who cut her consumption of Coca-Cola, swears she would not
have managed to change her habits without her weekly telephone call from
a health counselor and monthly support groups, programs funded by the
University of Alabama at Birmingham and the federal government. The
meetings are fun, like church socials, she says. In two years, she has
missed only one.
Four
t of her 14 siblings and half siblings have diabetes. “If I wasn’t
going to the class, I’d probably be on all kinds of medications,” she
said.
Still,
it is unclear whether these improvements are affecting overall rates of
new cases in the Black Belt. The C.D.C. does not measure new cases by
county.
Dr.
Monika Safford, an internist School of Medicine, at the University of
Alabama at Birmingham, who has conducted random trials with community
health workers in the Black Belt, found patients lost weight and improved blood pressure but had no change in glucose.
“Individually there have been some successes, but as an epidemic, I don’t think we’ve made a dent,” said Dr. Roseanne Cook, a physician at the Pine Apple Health Center.
Others detect a meaningful shift in people’s attitudes. When Kim Catlin, a nurse with the Bryan W. Whitfield Memorial Hospital in Demopolis, began preaching better health in church basements and health centers in rural Alabama in 2007, she was met with blank stares.
“There was no education about it, I mean nothing,” she recalled. “It was: ‘Blood sugar, what? Blood pressure who?’ They didn’t know what these things were.”
Now, she said, “people are more conscious of what they are eating. They are more active.”
For Ms. Carpenter, the result has been a better life.
“Baby,
I got my self-esteem going and I’m gone,” she said. “It used to be,
‘All you ever do is sit up in the house.’ Now it’s ‘You ain’t never
staying at home.’ ”
