Kentucky, in Diabetes Belt, needs to do more to keep percentage of residents with costly disease from rising, advocates say

By Dr. Gilbert Friedell and Isaac Joyner

World Diabetes Day is Nov. 14, and we urgently need to address this plague right here at home. Diabetes is a major public health problem — an epidemic — in the United States. One out of 10 people over the age of 20 now has diabetes, primarily Type 2 or “adult onset” diabetes, and the disease is rapidly increasing. This increase has been particularly striking in the several Southeastern states comprising what the federal Centers for Disease Control and Prevention calls the “Diabetes Belt.”


In Kentucky, one of eight people now has the disease — a frightening fact. Even more frightening: one-fourth of those with diabetes do not know they have the disease! If this epidemic is not interrupted, by 2050 about one out of three people in this country will have diabetes. For minorities, that figure will be closer to one out of two.

Diabetes itself poses a significant health problem, but the real burden of the disease is its complications. The high blood-sugar levels characteristic of diabetes, plus the effects of high blood pressure and elevated cholesterol levels, damage both small and large blood vessels. Over time, those with diabetes frequently go blind, have a toe or foot amputated, lose kidney function and frequently die of a stroke or heart attack.
These complications are BAD: blindness, amputations and dialysis.

The cost of diabetes is staggering. In 2025 its annual direct and indirect cost to the country is projected to exceed $500 billion. Here’s what we need to do about this epidemic.

First, we need to focus on primary prevention of the disease, and that means stressing proper nutrition and regular exercise. Early childhood is the time to begin good dietary habits, and the conscious selection of food for school snacks and lunches provides an excellent opportunity for establishing these habits.

With young people and adults, a structured program of weight loss and exercise can prevent the onset of diabetes among about half of the overweight population that has elevated but not diabetic levels of blood glucose.

At the community level, we need active engagement by local health departments and officials interacting with the population. We recommend the creation of broad-based Community Diabetes Control and Prevention Councils, with health providers, business leaders and teachers, along with diabetes patients and their advocates.

At the state level, we need mandatory screening of all adults, and mandatory reporting of all new cases of diabetes to a state diabetes registry.
Strong support from the federal government must be provided for these efforts, and for local health departments.

Diabetes prevention will require a significant change in the behavior of patients, health providers, communities and government.
This will not be easy, but the current fragmented way in which we deal with diabetes is not working.
It is long past time for greater public recognition of the grave threat that the diabetes epidemic poses — and for a rational, coordinated response to it.

Gilbert Friedell and Isaac Joyner, of Lexington, are co-authors of The Great Diabetes Epidemic: A Manifesto for Action.

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