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Lisa Miller and Sanford Miller enrolled in a Methodist Hospital's diabetes prevention program each loosing over 20 pounds after Sanford was diagnosed prediabetic and both registered high cholesterol.(Photo: Jim Weber, The Commercial Appeal)Buy Photo

Construction worker Sanford Miller rarely ate a midday mealthat didn't include a fast-food burger andfries because, as he says, "that's what you did for lunch."

Not any more.

With his weight, cholesteroland blood-sugar levels surging, Miller, 56, decided to make a change. He and his wife Lisa joined a diabetes-prevention class at Methodist Le Bonheur Germantown Hospitaland began taking walks and eatinga more healthful diet. TheMemphis native and Olive Branch resident not only shed nearly 30 pounds, but lowered hisblood-sugar levels from the pre-diabetes range to normal.

Much like Miller, Michelle Norman says she was"absolutely" destined fordiabetes, what with her family history and struggles to manage weight. But that was before she became an exercise devotee, bicycling up to 150 miles at a time and leading a regular Zumba class.Although still considered pre-diabetic, the 49-year-old Whitehaven resident has reversed the steady increase in her glucose levels, which now are dropping toward the normal range.

Miller and Norman are among a growing number of people acrossGreater Memphis and Tennessee who are eludingone of the region's most widespread and devastatinghealth problems diabetes without prescription drugs.Under the National Diabetes Prevention Program, local hospitals and healthcare providers are targeting pre-diabetic residents for intervention efforts focused mostly on diet, exercise and behavioral changes.

There are early, but tantalizing signs that the effort is helpingbluntwhat area health officials have described as an epidemic. The number of new diabetes cases diagnosed in Shelby County fell nearly 19 percent, from a peak of 7,918 in 2008 to 6,439 in 2013, the most recent year for which the Centers for Disease Control and Prevention has statistics.

Other urban counties in Tennessee have experienced similar drops. In Davidson County, new cases fell from a high of 5,201 in 2007 to 4,032 in 2013, while Knox County experienced a decline from 3,964 to 2,642 during the same period.

Not eventhose declines, however, change the fact that Type 2 or "adult" diabetes remains a major scourge. Greater Memphis,along with most of Tennessee, lies within what the CDC calls the "diabetes belt,"a 644-county region stretching from eastern Texas to West Virginia and the Carolinas in which 11 percent or more of the adult population has been diagnosed with the disease.

In Shelby County alone, more than 82,000 people, or 12.2 percent of the adult population, had diabetes in 2013, according to CDC data. Although thatfigurerepresentsa leveling-off from the previous twoyears, it'ssignificantly higher than2004, when fewer than 60,000residents, 9.4 percent of the adult population, had the disease. In Davidson and Knox counties, the percentage of adults with diabetes in 2013 was 10.6 and 11.2, respectively.

Characterized by an excess of glucose in the blood, diabetes is an incurable disease that can lead to nerve damage, blindness, kidney disease, heart trouble and death. It kills nearly 250 people in Shelby County each year.

The disease also presents a crushing cost burden. People diagnosed with diabetes at age 50 will spend up to $135,600 more in lifetime medical costs than those without it, according to a 2014 study.Nationally, the disease produces an annual$245billion drain on the economy, including$5.8 billion in Tennessee.

But while it may not be curable, diabetes is clearly preventable, even among those who are especially at-risk because theirblood-sugar levels have reached the pre-diabetic stage.

Dr. Sam Dagogo-Jack, professor of medicine and chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center in Memphis, helped lead a major studyshowing that lifestyleand diet changes can reduce by up to 58 percent the occurrence of diabetes amongpeople who are pre-diabetic. Lifestyle and diet, the study showed, wasalmost twice as effective as medication in preventing the transition from pre-diabetes to diabetes.

"We can prevent the progression from pre-diabetes to diabetes, and even sweeter still, we can observe remission from pre-diabetes back to normal glucose levels," Dagogo-Jack told The Commercial Appeal in a 2015 interview.

While 29.1 million Americans have been diagnosed with the disease, 86 million others have pre-diabetes. Because it typically takes five to 10 years for pre-diabetes to turn intoto diabetes, specialattention should be focused on that lattergroup, Dagogo-Jack said.

"Very few diseases give you that much of a window of opportunity for intervention."

People at-risk for diabetes include those who are obese, overweight and sedentary, orhave a family history of the disease. Also, certain ethnic groups, including African-Americans, are more predisposed to diabetes.

Jennifer Reed, diabetes program manager at the Baptist Medical Group Outpatient Care Center, said just the loss of 5-10 percent of body weight can have a "tremendous effect" on blood-sugar levels. She citessugary drinks, particularly thatSouthern favorite, sweet tea, asa good place to start cutting back.

Kristy Merritt,diabetes education coordinator, Methodist Le Bonheur Germantown, instructs at-risk people how to eat healthier, become more active and manage their stress. She said that among arecent class of nine participants, the average weight loss was 7.65 percent, and, by the end of the program,all had reduced blood-sugar levels to the point they were no longer pre-diabetic.

At Church Health, at-risk patients are assigned health coaches help thembecome more active and improve their diets and behavior. It's led to significant reductions in blood-sugar levels, said Dr. Scott Morris, CEO, and the effort should become even more successful with the organization's imminent move to Crosstown Concourse, where the Church Health YMCA is opening.

Preventing diabetes has become a major focus of private-practice physicians in the city. Patients of Dr. Beverly Williams-Cleaves benefit fromthe workout room and learning kitchen at her practice on Lamar. "Between the exercise and nutrition, I have several (pre-diabetic patients)who have totally corrected" their blood-sugar levels, she said.

David Sweat, chief of epidemiology for the Shelby County Health Department, said the key to controlling diabetes is reducing the area's high rate of obesity. There are some hopeful signs in that regard, as well. CDC figures show a slight dip in the county's obesity rate, from 34.7 percent in 2011 to 32.3 percent two years later.

Sweat said the recent addition of walking and bicycling trails is having an effect.

"It's very heartening. If you're out on the (Shelby Farms) Greenline, or atShelby Farms, you see a lot of people walking, biking and hiking," he said.

Reach Tom Charlier by email at thomas.charlier@commercialappeal.com, by phone at (901) 529-2572, or on Twitter at @thomasrcharlier.

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Programs help blunt Memphis' diabetes epidemic - The Commercial Appeal

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