Already dubbed America's "stroke belt," the southeastern U.S. just earned another dubious distinction as the nation's "diabetes belt," government researchers said Tuesday.
They used county-by-county data to mark those areas where people are most at risk for the blood sugar disease.
"We have known for a long time that diabetes was more common in the Southeast than it was in the rest of the nation, but in many ways that's not an adequate definition," said Lawrence Barker of the Centers for Disease Control and Prevention (CDC) in Atlanta, who led the work.
Having more specific data and a defined diabetes belt "allows us to identify areas where the need is greatest and where we can direct our attention and efforts to prevent and control diabetes," Barker said.
Almost 26 million people in the United States have diabetes, according to the American Diabetes Association.
Annual treatment costs top $100 billion, and people with the chronic disease are also at risk for other medical conditions, including heart disease, kidney damage, and some kinds of cancer.
Using national health surveys, Barker and his colleagues were able to construct a map of the U.S. in terms of diabetes rates.
What emerged was a clear trend of high diabetes rates in parts of 15 different states, including Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas ,Virginia, West Virginia and the entire state of Mississippi.
Close to 12 percent of people in the diabetes belt had the disease, compared to 8.5 percent in the rest of the country, according to the new report, which appears in the American Journal of Preventive Medicine.
Some isolated counties in other states also had high rates, but were not included in the diabetes belt because they were not clustered with other counties that had high diabetes rates.
From the health surveys, the CDC researchers found that people living in the diabetes belt were more likely to be obese and have a sedentary lifestyle than people in the rest of the U.S.
Those lifestyle factors alone accounted for almost one-third of the difference in diabetes rates inside and outside the diabetes belt.
The region also had more residents over 65, as well as a greater percentage of African Americans, who are known to be at an increased risk of diabetes.
But even young people with a slim waistline were more likely to have diabetes if they lived in the belt than if they lived outside it, the researchers found.
Barker said it's still not clear why that is.
"We suspect there are cultural factors that are very hard to measure, for example traditional diet (or) attitudes toward seeking medical care" that would affect a person's risk of diabetes, he said.
The diabetes belt overlaps considerably, though not completely, with the stroke belt and the recently defined heart failure belt (see Reuters Health story of February 2, 2011.)
The CDC researchers said policy makers should now focus their efforts to prevent diabetes on those counties that need them the most, for instance by launching healthy-lifestyle and anti-obesity campaigns.
Dr. Lawrence Phillips, who studies diabetes at Emory University and was not involved in the current study, said the most important thing right now is for doctors to find those people in the diabetes belt who have the disease but haven't been diagnosed, or have pre-diabetes and aren't being treated.
The diabetes statistics in the study are likely an underestimate of the true prevalence of diabetes, Phillips said, because some people who were polled probably had diabetes but didn't know it.
"Since diabetes is one of what we call the silent killer diseases ... it's important for the public to be aware that this is a problem," Phillips told Reuters Health. He said that having a defined diabetes belt should help highlight that message.
"What this does is to give health care providers ammunition," Phillips said. "A provider can say, 'We're in the diabetes belt. All of these things are increased in part because of the way we live, and all of these things can be improved to a certain extent. Our risks can be decreased ... by eating healthier and to the extent that we can, being less sedentary.'"