"The 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."

-- Judy Jones,
interim director,
UK Center for Rural Health

Oct. 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 rural communities.

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 here.