Description: Age-adjusted death rate per 100,000. The 5 year aggregate is used because it is a more stable measure (since the deaths in any one year is a relatively small number). Age-adjusted data means that the age distribution of the population is controlled for so this rate can be used to compare to other counties within the state that might have an overall younger or older population.

Highlights: Since 2011, the diabetes mortality rate has been approximately 3 times higher for African Americans than for Whites. This inequity has not changed significantly.

Source: NC State Center for Health Statistics, County Health Data Book, Mortality section. The report is labeled, "Race/Ethnicity-specific Age-adjusted Death Rates". Updated annually. http://www.schs.state.nc.us/data/databook/

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

While diabetes prevalence in Buncombe County is slowly decreasing, the 5-year aggregate age-adjusted mortality rate has increased from 11.3/100,000 in 2011 to 15.3/100,000 in 2014. Though there are many factors contributing to this increase, this may suggest that people with diabetes are struggling to manage this chronic disease. The large racial disparity also suggests that managing diabetes is even more difficult for African-Americans than for Whites in our community. Research suggests many possible barriers to diabetes self-management, including limited health literacy and/or access to self-management information, the cost of medication, the limited availability and high cost of fresh foods vs. processed foods, and a historical mistrust of physicians in certain minority communities.

There are several initiatives working directly to overcome these barriers in the county. MANNA Foodbank and the Community Service Navigators organize "pop-up markets" regularly in housing communities, where residents cannot only get free healthy, fresh food, but they can also participate in health screenings and education and get connected to community-based disease management programs like those at the YMCA, YWCA, and Land of Sky. The Minority Health Equity Project, funded by the state CFEHDI grant, helps organizations that focus specifically on African-American and Latino health to collaborate and pool resources for greater impact. Clinical and community partners have also worked to increase physician referrals to community-based diabetes education and management programs to increase participation, and the number of primary care practices now certified as Patient Centered Medical Homes means that more disease management support will come from those practices.

Though Buncombe County has quality health care providers, many community resources and promising initiatives, there is more to be done. There is a deep distrust of the medical community in some parts of the county, and a perception in some areas that diabetes is "normal." Many people with diabetes are either confused by the information they receive or do not have the information they need to successfully manage the disease. In addition, the large group of uninsured or under-insured residents, due to North Carolina's decision not to expand Medicaid, means access to physicians and medication is a challenge, and limited public transportation presents more access problems. Even though there are many organizations that offer instruction in food-growing and cooking, there isn't yet a system for referring patients with diabetes to these kinds of supports.

General Strategies to Improve Diabetes Management and Decrease Diabetes Mortality:

Disease Management Programs: Disease management is an organized, proactive, multicomponent approach to healthcare delivery for people with a specific disease, such as diabetes. Care is focused on and integrated across the spectrum of the disease and its complications, the prevention of comorbid conditions, and the relevant aspects of the delivery system. To read more about the evidence base for disease management programs, go here.

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

Taking Control of Type 2 (YMCA): TCT2 is an innovative and evidence-based program that empowers participants to embrace a balanced approach to diabetes self-care. TCT2 uses three pillars of support to encourage self-management of type 2 diabetes: medical management, healthy eating, and physical activity. By giving individuals with diabetes enough time, a safe place, accurate information, and a plan for practical application, participants find their own unique way to manage type 2 diabetes, making self-management sustainable.

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

Community Service Navigators (Health & Human Services): Community Health Workers and Educators are and evidence based way to improve diabetes management. health educators, case managers, lay health and community health workers, and peer counselors or educators have been shown to contribute effectively as part of the DSME team and in providing diabetes self-management support

Dale Fell Health Center: The Dale Fell Health Center opened in early 2016. Increasing evidence suggests that targeting high risk communities and providing services directly within those communities is a highly effective way of increasing health status and meeting community need. Another example of this is the Memphis Congregational Model.

Now:

• Revisit, update, and promote diabetes referral tool developed in 2014-15 (revision completed)
• Flesh out and share the "service map" created at 7/7 meeting so that EVERYONE will have the full picture and details of each service. (draft completed; editing in progress)
• Build respectful structure for community input (especially African-American & low-income community members) (CHIP proposal completed; work beginning)
• Create more trust and cross-referral among existing diabetes prevention & management education programs--reduce sense of "competition" (ongoing)

6-12 Months:

• Increase client DEMAND for diabetes prevention and management programs & services
• Work with

1-3 Years:

• TBD

Beyond:

• TBD

For more information visit the Diabetes Workgroup Blogsite

North Carolina Health Trends Interactive Map