Tackling the diabetes epidemic in Oklahoma (Guest Post: Breanca Thomas)

Breanca Thomas is a PhD student in Health Promotion Sciences in the College of Public Health at the University of Oklahoma Health Sciences Center and a 2013-14 OK Policy Research Fellow. She intends to pursue a research career focusing on effective methods of reducing health disparities among at-risk groups.

Diabetes is one of Oklahoma’s most serious health epidemics. Oklahoma has the seventh highest Type 2 diabetes rate in the country, and between  1995 and 2010, rates of diabetes rose by 226 percent. Diabetes develops when one’s body becomes insulin resistant, and cannot effectively regulate its blood sugar. If diabetes is not managed properly, it can lead to serious medical complications with poor circulation, vision, and kidney function. Oklahoma has a diabetes rate of about 11 percent, and the state has the fourth highest death rate from diabetes in the U.S. In 2011, $185 million was spent on diabetes-related hospital admissions in Oklahoma.

Though Oklahoma’s problem with diabetes is both financially and physically costly, solutions to this issue can be relatively complex. First, a major cause of diabetes is obesity;  80 percent of Type 2 diabetics are obese at the time of their diagnosis. About 30 percent of Oklahoma adults are obese, while 66 percent of Oklahoma adults are overweight or obese. Second, Oklahoma has a large population of low-income individuals. This group is at particular risk for diabetes because they often live in areas that lack access to affordable and healthy foods, and also have higher obesity rates than higher income groups.

Finally, Oklahoma has among the largest American Indian populations in the nation. This group tends to have a strong family history of diabetes, and to live in rural areas with low food security. The diabetes rate among American Indians in Oklahoma is 16.4 percent, compared to 10.3 percent for non-Hispanic Whites. African-Americans (13.5 percent) and multiracial individuals (16.2 percent) also experience high diabetes rates in Oklahoma. Combating diabetes in Oklahoma involves addressing these key groups—the obese and overweight, low-income, and racial/ethnic minorities— which often overlap with one another.

Reducing diabetes is simple in theory: studies show the cheapest and most effective methods for both preventing and managing diabetes are physical activity and healthy eating habits. However, diabetes is a population-wide issue in Oklahoma, and individual-level approaches may not suffice for Oklahoma’s widespread diabetes and obesity problems. Most Oklahoma adults and adolescents do not participate in recommended amounts of physical activity or fruit and vegetable consumption. Promoting these individual-level health behaviors involves developing interventions for small groups of at-risk individuals, or educating people about the importance of healthy eating. Even though these interventions often target the at-risk groups mentioned above, these interventions usually last for a limited amount of time, and do not involve most of the Oklahomans who need it.

Oklahoma has taken more widespread steps to both manage and prevent diabetes in the state. World Diabetes Day takes place annually at the State Capitol, and involves free diabetes screening and advice for healthy living. Through the Oklahoma State Department of Health, Oklahoma participates in programs supported by the Centers for Disease Control and Prevention (CDC), such as the Oklahoma Diabetes Control and Prevention Program and the CATCH Kids Club. Even though these programs support reduced rates of diabetes and obesity, similar programs are contingent on continued CDC funding.  

Since 2001, 29 different pieces of state legislation related to physical activity and nutrition have been passed in Oklahoma. They mostly involve resolutions that encourage healthy behaviors in Oklahoma communities and school districts. Some, like Safe Routes to School, require schools and districts to apply for grant funding or to develop their own program to participate in given programs, which may be problematic for rural areas with low capacity.

Oklahoma may consider more population-based methods to reduce diabetes. OK Policy has previously discussed issues of food security in Oklahoma. Healthier eating may be improved by increasing access to quality and healthy foods through programs like SNAP (Supplemental Nutrition Assistance Program, formerly food stamps), and encouraging grocery stores in low-income and rural areas to lower the pricing on fruits and vegetables. In terms of physical activity, studies have shown that individuals in low-SES neighborhoods are less likely to participate in physical activity and perceive more neighborhood crime and uncleanliness than high-SES areas. Low-income neighborhoods often lack recreational facilities, consistently placed sidewalks, so residents lack the ability to be physically active.

Oklahoma has taken steps to reduce the prevalence of these diabetes and obesity. However, solutions that remove barriers to the behaviors that lead to obesity and diabetes may be more effective than individual-level education alone, especially for at-risk groups.

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