disease is on the rise. It's on a shocking scale upward,
but the problem is that it's also occurring in the
places of the state where access to health care is
the most lacking."
UK Center for Rural Health
9, 2002 (Lexington, Ky.) -- In 1994, diabetes
in Kentucky stood at the national norm, but by 2000,
the disease had reached near epidemic proportions
and the prevalence of the disease in the Bluegrass
state was among the highest in the nation. According
to a study just released by the University
of Kentucky Center for Rural Health, diagnosed
diabetes is 67 percent more prevalent in Kentucky
today than it was in 1994. The disease is most prevalent
in rural Eastern and Western Kentucky.
"The disease is on the rise," said Judy
Jones, interim director of UK Center for Rural Health.
"It's on a shocking scale upward, but the problem
is that it's also occurring in the places of the state
where access to health care is the most lacking."
Lifestyle changes are difficult to sustain, and in
Kentucky the challenge is even more daunting because
40 percent of the working-age population have modest,
minimal or no functional literacy skills. Worse, there
is little social support and few appropriate role
models, especially in the rural areas of Kentucky.
Changing life-long behaviors requires education and
intensive support by people who have credibility in
Kentuckians have some of the greatest risk factors
for diabetes, including:
-- Kentucky leads the nation in the percentage of
people who lead sedentary lifestyles, a major risk
factor for diabetes;
-- Kentucky ranks among the top 10 states for obesity,
another of the major risk factors;
-- Older people are at higher risk for diabetes,
especially when other risk factors are present and
Kentucky is projected to be among the top five oldest
states by 2020; and
-- Kentucky leads the nation in smoking, which worsens
the complication of diabetes.
While Kentucky has a unique challenge, the state
also has a unique resource: the Kentucky Homeplace
program. Homeplace is one of the nation's largest
and best-sustained lay health worker programs, enjoying
support of the Kentucky General Assembly since its
inception in 1994. Kentucky Homeplace deploys 41 lay
health workers in 39 rural Kentucky counties, using
resourceful local people to help others gain access
to existing services.
"While Kentucky has one of the worst situations
in the nation in terms of prevalence of diabetes,
we feel we have a very innovative and unique tool
in addressing the problem with Kentucky Homeplace,"
said Jones. "What we're hoping to do is deploy
some new strategies among our lay health workers to
see if they can accelerate their efforts to address
diabetes among the clients we serve."
In 2001-2002, 23.2 percent of the clients served
by Homeplace suffered from Type 2 diabetes. The only
condition more prevalent among Homeplace clients was
hypertension (29.6 percent.) The program has established
protocols, extensive training and pen/tab computers
to collect and aggregate data in real time. These
lay health workers are stationed across the state,
from rural Western Kentucky where there are pockets
of Latino migrant health workers established on soy,
corn and tobacco farms and in poultry producing plants.
Western Kentucky also has rural African American
populations, in some counties rising as high as three
times the state average. In rural North Eastern Kentucky,
Latinos are newly emerging but are almost completely
disenfranchised from the health care system. In rural
Southeastern Kentucky, a century of coal mining has
rendered an aging Caucasian population that has poor
health indicators, low literacy skills and chronic,
ambulatory sensitive diseases.
Experience of Kentucky's lay health workers has shown
that only 10 percent of the time devoted to sustaining
good health is spent with health
professionals. The remaining 90 percent of health
care occurs at home. That's where the Kentucky Homeplace
program has demonstrated its ability to reduce health
care costs by helping people manage their diseases
more effectively. Diabetes is best managed on a day-to-day
basis, with proper diet, exercise, foot care and monitoring
of blood-sugar levels.
For more information, call (606) 439-3557 ext. 282
or visit the center's Web site by clicking