S.A. Denham, K.E. Remsberg, & L. Wood

Ohio University, Athens, Ohio

Diabetes: A Family Matter ConferenceMarch 18, 2009

Graduate assistants who contributed to this project by distributing surveys and compiling data were: Cara Butcher Tammy Collier Eimi Lev Patricia Harris Stacey Hartman Tara O’Brien

Funding sources: CDC’s National Diabetes Education Program, Ohio Department of Health Diabetes Prevention and

Control Program Ohio University, Diabetes Research Initiative &

Appalachian Rural Health Institute, College of Health & Human Services, School of Nursing

Prevalence of diabetes, U.S. 2008 all ages* Total: about 24 million people (7.8% of the

population) Diagnosed: 17.9 million people Undiagnosed: 5.7 million people

1.5 million new cases diagnosed in 2005

Mortality 7th Leading cause of death Under-reported (only 35-40% with diabetes had it

listed on death certificates) Twice as high as for others without diabetes

(2007) Direct costs $116 Billion Indirect Costs $58 Billion

BRFSS [2006], CDC/Div. of Diabetes Translation 6.6 to 10.1% said yes to “Did a doctor tell you that you have diabetes?”

0

2

4

6

8

10

12

14

1999 2002 2005

Greater Cincinnati 1st generation White Appalachian

2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book

02468

1012141618

GreaterCincinnati

1st gen. WhiteApp.

2nd gen. WhiteApp.

Diabetes

2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book

0

2

4

6

8

10

12

App. Ohio `06 Ohio BRFSS `04 US BRFSS `04

Diabetes

2006 ARHI

US Prevalence About half of those with diabetes have taken a class on

diabetes self-management, (52%) Those older than 65 years of age are less likely (46%)

Diabetes Education and Insurance (under 65 years) Uninsured (42%) Medicare (46%) Medicaid/Indian Health Service (49%) Private Insurance (54%) Veterans Administration (79%)

Other traits and Diabetes Education More likely

Female African American Insulin Use

Less likely Appalachian (Virginia Dept. Health, 2004)

Evaluate provider perceptions about the provision of diabetes education throughout the Appalachian region of the United States.

Distressed County Poverty 1.5x national average Unemployment > 1.5x national average Per capita market income no more than 2/3

national average OR, poverty 2x national average, plus

unemployment or PCMI

At-Risk County Poverty ≥ 1.25x national average Unemployment ≥ 1.25x national average Per capita market income no more than 2/3

national average OR meeting 2 of 3 distressed criteria

Federally Qualified Health Centers N = 135 (54 clinics/hospitals and 81 HD)

Health Departments N = 82

Diabetes Educators N = 47 (46 situated in hospitals/clinics

and 1 in a HD)

A 40-item questionnaire

Information collected from the survey: Amount, type of diabetes education available Providers of education Patient barriers to receiving education Provider obstacles to delivering education

Descriptive analyses of factors assessed by provider perceptions of Diabetes Education.

Cross-sectional comparison of percentages according to Distressed-At-Risk County status

P-values ≤ 0.05 were statistically significant

VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value

Level of Rural-UrbanLevel of Rural-Urban

RuralRural

MixedMixed

UrbanUrban

48.8%48.8%28.0%28.0%23.2%23.2%

3.0%3.0%30.0%30.0%67.0%67.0%

< 0.001< 0.001

Type of SiteType of Site

Clinic/HospitalClinic/Hospital

Health DepartmentHealth Department

48.8%48.8%51.2%51.2%

60.0%60.0%40.0%40.0%

nsns

Percent of Population 0-17yo in 2000Percent of Population 0-17yo in 2000 23.9%23.9% 22.9%22.9% 0.0070.007

Percent of Population in poverty, 2000Percent of Population in poverty, 2000 20.5%20.5% 12.9%12.9% <0.001<0.001

Health, Social and Educational Health, Social and Educational WorkersWorkers

19.9%19.9% 21.2%21.2% nsns

Physicians, mean # per 100,000Physicians, mean # per 100,000 59.159.1 166.9166.9 < 0.001< 0.001

VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value

Any Diabetes Education Programs Any Diabetes Education Programs

Separate Type 1 and 2 classesSeparate Type 1 and 2 classes

Family ParticipationFamily Participation

59.4%59.4%12.8%12.8%84.8%84.8%

44.8%44.8%27.5%27.5%78.3%78.3%

0.1010.1010.0920.092

nsns

Classes on a Single DayClasses on a Single Day

Length of Classes, 1-2 hoursLength of Classes, 1-2 hours

51.2%51.2%36.4%36.4%

31.3%31.3%34.8%34.8%

0.0540.054nsns

Primary Educator, CDEPrimary Educator, CDE 10.4%10.4% 30.9%30.9% 0.0010.001

Primary Educator, NursePrimary Educator, Nurse 46.7%46.7% 35.1%35.1% nsns

VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value

Travel TimeTravel Time 37.337.3 39.039.0 nsns

Gas MoneyGas Money 70.170.1 56.156.1 0.0780.078

LiteracyLiteracy 38.838.8 47.647.6 nsns

Lack Public TransportLack Public Transport 64.264.2 51.251.2 nsns

Fail to Keep AppointmentsFail to Keep Appointments 67.267.2 78.078.0 nsns

No Phone to ScheduleNo Phone to Schedule 28.428.4 30.530.5 nsns

No One to Drive ThemNo One to Drive Them 68.768.7 63.463.4 nsns

Poor Personal HealthPoor Personal Health 40.340.3 47.647.6 nsns

Lack InsuranceLack Insurance 40.340.3 64.664.6 0.0030.003

VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value

Lack StaffLack Staff 39.539.5 22.022.0 0.0140.014

Lack InsuranceLack Insurance 31.631.6 61.561.5 < 0.001< 0.001

Lack SpaceLack Space 17.117.1 9.99.9 nsns

Lack TimeLack Time 34.234.2 31.931.9 nsns

Lack Teaching ResourcesLack Teaching Resources 31.631.6 18.718.7 0.0540.054

Patient Reading LevelPatient Reading Level 13.213.2 12.112.1 nsns

Provision of Diabetes Education - Appalachia: DAR may not be worse than NDAR Provider needs: Lack of resources, medical

specialists, staff and CDEs to provide diabetes education Patient barriers: Lack of transportation, insurance,

literacy

Perception/reality of increasing diabetes, costs Lead to further discrepancy between diabetes

and education/care needed.

Fewer CDEs available in DAR, educators more likely to be busy RNs

CDEs more likely to be employed in hospitals than clinics and health departments

Fewer people in the Appalachian region appear to be getting diabetes education than nationally

Broad inclusion of family in diabetes education

Barriers (e.g., costs, distance, etc.) need to be addressed locally

Low literacy and health literacy