Can direct intervention models work in diabetes management?

Tennessee is a state with an obesity epidemic, a fact that a team of reporters at The Tennessean has been exploring from many angles for the past two years and that Gov. Bill Haslam identified earlier this year as the state’s top health priority. While the overall American population has gained weight in recent decades, Tennesseans got fatter faster. One of the many results of that epidemic is a large percentage of the population with diabetes. Just over 10 percent of Tennesseans had been diagnosed with diabetes as of 2010, according to data from the U.S. Centers for Disease Control and Prevention. In the mid-1990s, that percentage had hovered around 5 percent.

I want to juxtapose the commonality of diabetes against the horror of the disease. There a hot zones for this disease in Tennessee – households where the grandmother, the mother and the grandchild all have diabetes, neighborhoods where it afflicts just about every other residence along a street. A community health center in Nashville has started a pilot project to address the problem on the frontlines. It has a team composed of a nurse, nutritional coach and fitness trainer working with these families. That FQHC, United Neighborhood Health Services, recently received a federal grant to put a diabetes management center in one of its clinics. The money will help this community health center widen the scope of its work. While the center will not open until after next January, I can shadow this team and get to know the actual families it works with. I want to tell this story from their perspective. Too often, reporters get the stories about behavioral health issues from the lips of health care providers. The big failures and the small, successive achievements that lead to better health outcomes go untold. I plan to use my fellowship grant to give these families a voice so they can tell their own stories and do it without strangers in their homes. There is also a Nashville hospital that has a outreach team going into diabetic households to help families change behavior problems. I am working with this team as well.

There is another story angle that I also want to pursue related to behavioral health and obesity. Too many Tennesseans are on waiting lists for kidneys as the result of prolonged hypertension. There are not enough kidneys being donated to meet this demand. No family members can step up to possibly be a live donor because they also have high blood pressure and other obesity-related diseases. Renal failure is especially prevalent among African-Americans in Tennessee.

The Tennessean’s work on obesity received recognition this week when the Tennessee Press Association awarded the newspaper first place for news reporting. We still think there is more to tell here. Last year, much of our focus was on childhood obesity, prevention programs, state policies and psychological issues surrounding obesity. Diabetes and hypertension merit a closer look.