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Exploring the epidemic: Q&A on diabetes in Tennessee with Dr. Lisa Staton

Key Takeaways

  • Tennessee ranks #6 in states with the highest rates of diabetes. All 95 counties have higher rates than the national median.
  • BlueCross care managers provide personalized support for members dealing with diabetes.
  • BlueCross will continue working with primary care providers, community partners and legislators to address population health and promote diabetes prevention.

Did you know diabetes can cause depression?

It’s true, and here in Tennessee, it’s a fact that affects many of us every day.

“More than half a million of us in Tennessee are living with type 2 diabetes,” says Dr. Lisa Staton, medical director for BlueCare Tennessee, “and that puts us at higher risk of health problems such as heart attack, blindness, kidney failure and amputations. The good news is that all of these risks can be managed, and at BlueCross, we help our members do that through outreach, support groups, online education, personal coaching — whatever it takes to help our neighbors get healthy.”

Here’s what Dr. Staton says we need to know about diabetes in Tennessee now. 

What kinds of problems can diabetes cause in a person’s life?

Dr. Staton: Diabetes takes a real toll on your body, causing excessive thirst, making you feel tired and causing blurry vision. But people who are struggling with diabetes also face other challenges with their finances, employment and productivity. We don’t think about it in those terms, but diabetes takes time and resources to manage. In fact, more personal health care resources are spent on diabetes than any other condition. At BlueCross, we are committed to giving our members living with diabetes the support they need so they can pursue the quality of life they deserve.

What factors are most likely to cause diabetes here in Tennessee?

Dr. Staton: Well, we’re more likely to be overweight, so that’s the single biggest driver of diabetes for us. Tennesseans are up against several health challenges, including not getting enough physical activity and using tobacco at higher rates. Nutritionally, we also rank low in our consumption of fruits and vegetables.

And then there’s the issue of comorbidity— having two chronic diseases at once — which means that if you have diabetes, you’re also more likely to have high blood pressure, for example, and vice versa. And that’s tough. When you’re dealing with a complicated medical history, you might start to feel hopeless, and we don’t want any of our neighbors here in Tennessee to feel that way. There’s always somewhere you can go for help and support.   

90% of people who have type 2 diabetes are overweight or obese.

Are there any factors that led to diabetes being such a big problem in Tennessee?

Dr. Staton: A lot of it is based on things we can change, especially when we’re young. Portion sizes are larger at restaurants, which leads us to consume more calories, and in some parts of Tennessee, we’re living in food deserts where we don’t have access to grocery stores and fresh foods. All of that plays a part, especially when some of us don’t have access to healthy, safe spaces to add activity to our day.

How is diabetes affecting our children?

Dr. Staton: As a whole, American kids today have access to more sugary sodas than previous generations, for example, and little issues like that add up. In Tennessee, we know our high schoolers in particular are less likely to eat fruits and vegetables, and our kids overall are more likely to be obese. That automatically puts our young people at higher risk of developing diabetes, and at BlueCross, we believe we have a responsibility to change that.  There are things happening at a very young age that are promoting unhealthy lifestyles, and we want to give kids and parents the resources they need to live healthier, happier lives.    

Tennessee ranks #6 in states with the highest rates of diabetes.

Is the diabetes epidemic in Tennessee getting better or worse?

Dr. Staton: In some ways, it’s getting better. Obesity and diabetes are connected, and while the obesity epidemic seems to be worsening, the rate of new diabetes diagnoses is decreasing. So that’s positive.

Adult obesity rates in Tennessee 1990-2018However, a record high number of Americans are living with diabetes or prediabetes.

In Tennessee, the rates vary by county, with urban counties generally having lower rates, followed by suburban counties, and then rural counties, which have the highest. But in Tennessee, all 95 counties have higher rates than the national median, so it’s definitely an issue we all have to tackle together.

How is BlueCross addressing diabetes in Tennessee?

Dr. Staton: First and foremost, BlueCross wants to educate members about how to make healthy choices. We want to teach people how to prevent and manage diabetes, and we want to offer them personalized support with care managers.

Our nurse care managers are required to have 5 years of clinical experience before they start working in these highly specialized roles, so we know they can create care plans that work. Some people like phone calls while others like texts. Some want to read about managing diabetes while others want to watch videos. Some need in-home eye screenings, telemonitoring of blood glucose or nurse visits. Because of the experience our care managers have, they can work with members to figure out what they need and make it happen.

How are we measuring the success of our efforts?

Dr. Staton: We’re looking at the health of our population. Is obesity declining? Are fewer people smoking? Are we seeing fewer complications from diabetes? The complications are big indicators, so we want to see decreases in:

  • Kidney disease and dialysis
  • Vision loss
  • Heart disease (stroke or heart attack)
  • Nerve damage

Measuring all those outcomes helps us understand where we’re moving the needle.

If someone is worried they might be at risk for diabetes, what should their first step be?

Dr. Staton: Talk to your doctor — that’s always step number 1. The American Diabetes Association (ADA) also offers a great online diabetes screening tool that can tell you your risk in less than a minute.

What resources do we provide members who struggle with diabetes?

Dr. Staton: The BlueCross website has a diabetes section where anyone can get help, whether you’re concerned about having diabetes or you’ve been managing it for years. What we at BlueCross really want people to understand is that even if you’re diabetic or prediabetic, we can help you get healthy so you can live the life you want. Lifestyle changes can help prevent complications, especially the big, life-changing ones like blindness, heart attack, stroke and amputation. If you manage your diabetes well, it doesn’t have to take over your life.

BlueCross is testing a digital care management app for members with diabetes. Read more here.

What advice would you give people who want to avoid becoming diabetic?

Dr. Staton: There’s a simple way to remember all the things you need to pay attention to. It’s A-B-C-D-E:

  1. Attitude: Adopt a positive attitude towards health and lifestyle
  2. Blood sugar: Know your blood sugar
  3. Control: Keep control over the things you can manage (blood pressure, blood sugar)
  4. Diet: Adopt a healthier diet
  5. Exercise: Aim to exercise 5 times a week for 30 minutes (moderate) or 3 times a week for 20 minutes (intense)

How will BlueCross efforts to curb the diabetes epidemic continue?

Dr. Staton:

  • We want our care managers to continue connecting with members who have questions, who are looking for guidance or who need help planning their treatment.
  • Diabetes Self-Management Education and Support (DSMES) is also a huge part of managing the disease, so we require all of our care managers who work with diabetic patients to meet ADA guidelines. That’s how we ensure they know the best, most current ways to help members manage their diabetes.
  • On a larger scale, BlueCross will continue working with primary care providers, community partners and legislators to address population health by promoting healthy lifestyles and prevention.

What’s the most important takeaway regarding this epidemic?

Lifestyle management matters. Medication helps some people, but it can’t fix everything.

  • Talk to your doctor so they can assess your complications
  • Connect with a care manager who can guide you through the process,
  • Know that lifestyle changes can make a huge difference when it comes to how diabetes will affect your life, and
  • Remember that you are not alone in dealing with your diabetes. We are always here to help.

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