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Everyone in Buncombe County is able to eat healthy, be active and better manage disease

Adult Diagnosed Diabetes Prevalence - Buncombe (WNCHI & BRFSS comparison)

7.3%2015

Data Description & Source

Description: Percent of Buncombe adults, 18 and older, who self-report diagnosis of diabetes

Source: Recent data comes from WNC Healthy Impact's Regional Telephone Survey www.wnchealthyimpact.com; comparison data is from the CDC's Behavioral Risk Factor Surveillance System (BRFSS).

Note: BRFSS data is not available at the county-level after 2012. Because it is helpful to see multi-year data, we have included the BRFSS data for that purpose. In the future, we will rely on WNCHI Regional Telephone survey, conducted every three years, beginning in 2012. Both sets of data can be viewed on this graph by using the "comparison toggle" function.

To view comparisons, click indicator title and the Toggle Comparisons button.

Story Behind the Curve

Diabetes in Buncombe County has decreased from 11.8% of the adult population in 2012 to 7.3% in 2015, which puts our rate below the Healthy NC 2020 target of 8.6% and below the national prevalence rate of 9.3%. However, the disparity in diabetes mortality between the White non-Hispanic population and the Black non-Hispanic population is startling. In 2014, for every 100,000 white residents, 14.2 died from diabetes; while for every 100,000 black residents, 40.0 died from the disease.

Buncombe County has many assets that keep the diabetes prevalence rate as low as it is and help address the racial disparity. First, there are several initiatives, such as Community Service Navigators, ABIPA's Faith Health Network and MANNA's "pop-up markets," that bring screening and education, fresh food, and connection to services into communities with large minority populations. The local YMCA and YWCA offer quality, affordable diabetes prevention education and fitness classes. In addition, many local primary care practices are now certified Patient-Centered Medical Homes, and community programs and clinical providers recently developed a Diabetes Clinical Referral Tool to make it easier for medical provider to refer diabetes patients into community-based prevention and self-management programs. Finally, Buncombe is a community that is committed to using evidence-based practices and using local data to learn where we are and aren't yet having an impact.

Despite this good work, partners have identified areas that still need to be addressed. In some communities there is a perception that having diabetes is "normal," and the number of people prioritizing regular exercise is low, so addressing these beliefs and attitudes will be important moving forward. Also, many residents still have trouble accessing services due to cost, transportation, and other barriers. In addition, healthcare providers do not currently refer patients to the many cooking and other skills-building classes available in the community. Other issues identified were language barriers (translation and health literacy challenges), lack of education (for both medical providers and those at-risk), and that the local ACO does not currently track diabetes data by race.

What Works

Early intervention and prevention activities with individuals and populations that are at high risk for developing diabetes are effective at reducing future diabetes diagnoses. Based on the evidence, combined diet and physical activity promotion programs are effective across a range of counseling intensities, settings, and providers. Programs commonly include a weight loss goal, individual or group sessions (or both) about diet and exercise, meetings with a trained diet or exercise counselor (or both), and individually tailored diet or exercise plans (or both). Higher intensity programs lead to greater weight loss and reduction in new-onset diabetes. Economic evidence indicates that combined diet and physical activity promotion programs to prevent type 2 diabetes among people at increased risk are cost-effective.

In Buncombe County these evidence-based prevention strategies have been effective:

Asheville Project (Asheville City): providing employees with diabetes intensive education through the Mission-St. Joseph’s Diabetes and Health Education Center and then teaming them with community pharmacists who made sure they were using their medications correctly

Diabetes Prevention Program (YMCA): helping those at risk of developing type 2 diabetes adopt and maintain healthy lifestyles by encouraging participants to eat healthier, increase physical activity and lose a modest amount of weight in a supportive, small group environment

Diabetes Wellness and Prevention Program (YWCA): empowering individuals with diabetes or those at risk of diabetes to develop the habit of exercise and reduce the incidence of diabetes through exercise and education that supports healthy eating, and promotes healthy lifestyle changes for the entire family

Early identification and intervention for pre-diabetes: Screening for pre-diabetes and supporting those at-risk to reduce caloric intake and increase physical activity for weight loss of just 5-7% of body mass. More here

Expanded Food and Nutrition Program (NC Cooperative Extension): Educating youth and parents of young children about nutrition, physical activity, and managing food resources since 1969

Nutrition and Physical Education in Schools: Teaching kids about healthy activity and nutritional choices can be effective in increasing activity levels and increasing healthy nutrition choices

Pop-up Markets with Navigators: Evaluation of practices suggests that strategic farmers markets are effective in increasing access to nutritious food when they partner with community organizations that currently serve the populations they are targeting. Currently Buncombe County HHS pop-up markets are working to increase access to nutritious food and services in low-income communities

Rainbow In My Tummy (Verner): cultivating a food culture surrounding young children that establishes a foundation for lifelong health

Action Plan

Now:

  • Communicate to community and partners EXISTING programs to increase referrals
  • Identify who to invite into this work
  • Find more responsive data (see "data holes" note)

6-12 Months:

  • Research evidence based interventions and strategies

1-3 Years:

  • TBD

Beyond:

  • TBD
Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy