Rate Of Increase In Diabetes Prevalence Reduced In Raleigh

Armen Hareyan's picture

An 8-year partnership among Centers for Disease Control and Prevention, North Carolina Department of Health and Human Services, Wake County Human Services resulted in a significant change in behavior related to diabetes prevention and care.

It reduced the expected rate of increase in the prevalence of type 2 diabetes in Raleigh, North Carolina, according to a report presented today at the American Diabetes Association's 67th Annual Scientific Sessions.

"Project DIRECT has been a successful program of outreach, health promotion, and diabetes care, in which the community participated in developing the interventions from the outset," said Desmond E. Williams, MD, PhD, a Medical Epidemiologist at the CDC and Project Officer of Project DIRECT, in a recent interview. "The rate of increase in the prevalence of diabetes was markedly lower in Raleigh compared to a comparable African American community Greensboro, 80 miles away." Improvements were also seen in numerous behaviors related to diabetes prevention and care.

Project DIRECT stands for Diabetes Interventions Reaching and Educating Communities Together. Although its research component has now ended, Project DIRECT has been institutionalized in Raleigh under the aegis of a local non- profit organization - Strengthening The Black Family, Inc. - with the support of that group, the CDC, the state and county health departments, and the community.


Nearly 21 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. It is the sixth leading cause of death in the U.S.

Type 2 diabetes involves insulin resistance - the body's inability to properly use its own insulin. It used to occur mainly in adults who were overweight and ages 40 and older. Now, as more children and adolescents in the United States become overweight and inactive, type 2 diabetes is occurring more often in young people. African Americans, Hispanic/Latino Americans, American Indians, and some other ethnic groups are at particularly high risk for type 2 diabetes and its complications.

Project Direct was designed to test the three-pronged "outreach, health promotion, and care" approach to diabetes prevention and care in the predominantly African American community of Raleigh, using Greensboro as a control community. Both have similar demographic and socio-economic characteristics, and populations of about 25,000.

"All of the local partners were involved in the Executive Committee responsible for planning and supervision of the project," said Joyce Page, MSPH, MPH, Director, Project Direct in the Diabetes Prevention and Control Program at the North Carolina Department of Health and Human Services. "However, the actual implementation of the interventions was done by local Project DIRECT staff, working in coordination with community members." They received support from members of the North Carolina Central University, and professionals living in and around Southeast Raleigh.

Suggested interventions were modified to make them culturally appropriate for North Carolina, and community members acted as ambassadors for the study to introduce the interventions into the community. The program, which included a church-based component, involved three key areas.