Food and Drug Administration considering product 'warning labels' to help Americans make healthier choices

Food sold in some Latin countries features bold
warning labels. (Adobe Stock photo)

To help Americans improve their diets, the Food and Drug Administration is "considering requiring food manufacturers to put new labels on the front of packages," report Andrea Petersen and Jesse Newman of The Wall Street Journal. "The labels might flag certain health risks, such as high levels of salt, sugar or saturated fat."

With the alarming rise in diabetes and cardiovascular disease in the United States, the FDA is exploring distinctive labeling on the front and back of packaging to help Americans make better nutritional choices. "One label idea the FDA has tested uses red, yellow and green to convey whether products are high, medium or low in added sugar, sodium and saturated fat," the Journal reports. "Other potential labels that the FDA has shared state how much of those substances a product contains per serving."

Food industry leaders indicated that they might sue the FDA should the labeling proposal become a rule, claiming the requirement "poses a threat to First Amendment rights and that only Congress has the authority to require it," the Journal reports. "Such labels could unfairly convey that certain foods are bad to eat, when in fact a candy bar may not be healthy, but consuming it in moderation isn't a problem, lobbyists said." Food industry proponents also insist the current labeling system is sufficient.

"The FDA says it intends to propose a rule on the labeling this summer."

So far, studies have supported the FDA's labeling idea. The Journal reports, "Scientific studies have generally found that front-of-package nutrition labels lead people to identify and choose healthier foods. More countries now require them on food and beverage containers. Others, including France, the U.K. and Australia, have voluntary programs."

In Chile, warning labels are put on products, and the country has seen dietary changes for consumers. According to Petersen and Newman, "After the warning labels were implemented, food manufacturers changed their products, too — by reducing the amount of sodium or sugar."

Rural residents with diabetes are more likely to suffer from disease complications -- lack of access to care could be why

Diabetes requires continuous care.
(Photo by T. Barbhuiya, Unsplash)

Past studies have shown that rural Americans are more likely to develop type 2 diabetes, and they experienced more struggles trying to manage the disease than their more urban counterparts. In a new study, researchers from the University of Maryland School of Medicine took a closer look at rural residents experiencing diabetes complications such as heart and kidney problems. Their research, which was published in the journal Diabetes Care, showed that these rural populations are at significantly higher risk of suffering from end-stage kidney disease, heart failure and heart attacks, all of which could caused by a lack of access to medical care.

The study's corresponding author, Rozalina McCoy, told UM news: "Those who live in rural areas have a greater risk of experiencing eight out of the eleven complications that we measured compared with those living in cities. . . .They were 15 percent more likely to have dangerously low blood sugar levels, which clearly indicates that their diabetes is not being managed properly."

The study's co-author, Elsa Davis, added, "While our study didn't address why these differences exist, we do know that people living outside of city areas are less likely to receive care from diabetes specialists, to receive diabetes self-management education, and to be monitored for diabetes complications."

While the study encompassed varying degrees of rural populations, it "relied on insurance information to identify diabetes complications," UM reports. "If people could not access medical care, that complication would not be captured. Dr. McCoy noted that this finding further underscored the barriers to care in remote areas: patients are likely having high blood sugar emergencies and heart failure but cannot get to the emergency department or hospital to have them diagnosed and treated." Study authors added that further research should investigate reasons why these disparities exist.

Dialysis centers have increasingly moved into rural areas, but travel still remains an obstacle, a new study finds

The treatment schedule ESRD requires means most
patients can't work. (Photo by Annie Spratt, Unsplash)

Once Medicare and Medicaid began covering dialysis costs, for-profit centers started opening in areas where larger clusters of patients live. A new study shows dialysis centers have increasingly moved into rural areas, reports Liz Carey of The Daily Yonder. Jan Probst, a researcher at the Rural and Minority Health Research Center in South Carolina, conducted a study that "looked at where dialysis centers are located and who lives in those areas, then compared the findings to similar past studies."

Dialysis cleans the blood, a job kidney organs usually do, but dialysis is used when kidneys fail due to end-stage renal disease. ESRD can be "caused by diabetes and high blood pressure, among other things," Carey writes. "Patients come to dialysis facilities and spend hours hooked up to machines that remove the blood from their body, filter it through an artificial kidney, and return it to the body."

In general, Probst's study showed that "rural residents have to travel farther to get to dialysis treatment facilities," Carey writes. "This isn't unexpected, she said. In the rural Southeast and Southwest, greater distances between communities mean those residents have to travel farther to get to their treatments. Rural residents, on average, have to travel just over 14 miles to get to the nearest facility. In contrast, urban residents live about 4.5 miles from the nearest dialysis center."

While rural residents still travel further for the expensive treatment, Probst notes her new study shows "a vast improvement from the last time Probst did the same research in 2013. In that study, rural residents had to travel about 40 miles to get to a dialysis facility," Carey writes. "The increase in access to dialysis centers isn't solely due to need, Probst said. Since her 2013 study, how dialysis is funded has changed. Now, federal policy requires Medicare and Medicaid to pay for dialysis treatments. And once Medicaid and Medicare guaranteed payment, Probst said, the market responded."

Even though most rural residents with ESRD may live closer to dialysis centers, the treatment is needed three times a week, and centers often don't offer evening or weekend care. Carey reports, "The burden dialysis places on rural patients would make maintaining any kind of job extremely difficult, Probst said." Probst told her: "I suspect that for most of these folks that [working] is not feasible, and they probably also have multiple things to deal with. They've lost their kidneys, but they still have to deal with their dialysis. There's a lot going on."

Wednesday quick hits: Oreo scandal; dead solar panels; photos of the year; the nurse shortage; food inflation dips

Is there less creme filling?
(Wall Street Journal photo)

Sometimes less is more, but sometimes less is just less, especially if you're talking about less filling in your delightfully creamed Oreo. "Oreo fans think there's less filing, but the Snack maker says it hasn't tinkered with creme ratio," reports Jesse Newman of The Wall Street Journal. "But suspicious consumers are on high alert."

Inquiring minds want to know: Where do dead solar panels end up? "The majority end up in landfills," reports Izzy Ross of Grist. "But there are no federal requirements for recycling solar panels, and states have different regulations for what to do with them. Panels can also contain small amounts of heavy metals like lead, which makes getting rid of them more complicated. The vast majority of panels are thrown away in landfills — only about 10 percent are recycled."

Photo by Louie Palu, National Geographic

It's finally time for the National Geographic photos of the year. A diverse and beautiful world awaits. In the photo, left, Finnish and U.S. soldiers train for winter warfare by navigating an obstacle course while on skis. The exercise took place two months before Finland — which shares an 800-mile border with Russia — joined NATO. The training was arranged in response to the war in Ukraine.

Is there a nursing shortage? That depends. "In 2022, the American Hospital Association quoted an estimate that half a million nurses would leave the field by the end of that year, bringing the total shortage to 1.1 million," reports Brittany Trang of STAT. "At the same time, National Nurses United insists there isn't a nurse shortage at all. There are plenty enough nurses for the country, they say — merely a shortage of nurses who want to work under current conditions."

Bill Watterson comic via
Mental Floss

When life gets too heavy, lift yourself up with some comics like Calvin and Hobbes. The wacky duo gets up to all kinds of shenanigans. The cartoon strip's artist was also a bit of a card himself.

After two years of stubborn food inflation, Americans can expect a slow drop in at-home food costs. "According to economists with the Department of Agriculture, while food prices are expected to remain higher in 2024, the rampant inflation rates experienced in 2022 and 2023 are anticipated to return to more 'normal' levels in the upcoming fiscal year, reports Charlsie McKay, RFD-TV News, which covers rural America.

Photo by M. Zilses, Unsplash

As the the holiday season approaches, it's time to consider how to eat all the treats you love without looking like you ate all the things you love. "What if the best way to curb sugar cravings is just to eat as much as you want? That is the core of an idea gaining traction among dietitians," reports Alina Dizik of The Wall Street Journal. "Who say that letting ourselves graze unfettered on a cache of Halloween fun-size Snickers can reduce our sugar lust in the long run."

To combat drug makers' increases in the price of insulin, states look at making it themselves; California will be first

Illustration by Sarah Grillo, Axios

As the price of some diabetes medicines continues to rise, states have looked at solving the problem on their own terms, with California the "first to enter the ring," reports Kaitlyn Levinson of Route Fifty. "As insulin prices have skyrocketed, states have intervened to lower them with price caps. California's decision to manufacture its own is leading other states to consider similar steps to ensure essential medicines are affordable to the public."

To claim that insulin prices are outrageous isn't an overstatement, reports Bob Herman of Axios. "These are the per-vial list prices for common insulin brands, according to Elsevier's Gold Standard Drug Database: Novo Nordisk's Novolog: $289 -- Eli Lilly's Humalog: $275 -- Sanofi's Lantus: $270."

When individuals don't have insurance, purchasing it isn't affordable, which has led to deadly outcomes. Levinson reports: "In 2017, a 26-year-old Minnesota man died after rationing his insulin. He did so because he was no longer covered by his mother's plan, and his job didn't offer insurance. Without coverage, he faced paying up to $1,300 for the drug, CBS News reported. His mother thought he could budget his remaining supply and pay for a new prescription when he could."

In 2019, Colorado capped a 30-day supply of insulin with a $100 co-pay. "California is the latest to adopt insulin co-pay price caps. . . .  (that) if signed into law, would limit insulin costs at $35 for a monthly supply," Levinson adds. But there is fear that the cap is not enough. "California is going beyond price caps to tackle insulin prices with an ambitious plan to produce the drug itself. Earlier this year, Gov. Gavin Newsom announced that the state is partnering with drug manufacturer Civica to produce $30 insulin vials and $55 packs of prefilled insulin injection pens."

In the past, other states have manufactured their own drugs, "From 1970 to the late 1990s, the Michigan Department of Public Health manufactured an anthrax vaccine," Levinson reports. "More than 20 years later, state lawmakers are revisiting public production, this time for insulin. If passed, a bill introduced in July would make $150 million available for Michigan to partner with private organizations to establish an insulin manufacturing facility. . . . Illinois and New York have also considered legislation to encourage affordable drug manufacturing. The bills aim to 'increase competition, lower prices and address shortages in the market for generic prescription drugs.'" 

Rural diabetics at Mayo had worse health results than urban ones, maybe because they see doctors and specialists less

Rural diabetics have slightly worse health outcomes than their urban counterparts, perhaps because they see diabetes specialists and other doctors less frequently, according to researchers at the Mayo Clinic in Rochester, Minn. Their study looked at 45,279 Mayo patients with a five-part standard for diabetes care called the D5 metric: absence of tobacco usage, maintaining hemoglobin A1C levels below 8%, keeping blood pressure below 140/90, using statin drugs, and taking aspirin. Forty percent of the rural patients met all five criteria while 43% of the urban patients did. 

"Rural patients had a lower average number of outpatient visits (3.2 visits) in contrast to urban patients (3.9 visits)," Mayo reports. "Furthermore, rural patients had fewer visits to endocrinologists, with only 5.5% attending such appointments, whereas 9.3% of urban patients did. . . . The researchers reached the conclusion that rural patients experienced poorer quality outcomes in managing their diabetes compared to urban patients, despite both groups being part of the same integrated health system. The study team speculated that the lower frequency of visits and limited access to specialty care in rural areas could be potential factors contributing to this disparity. . . . The authors of the study argue that broader interventions are necessary to enhance the quality of care provided by doctors to patients with diabetes residing in rural areas."

Rural people have long been more likely to die from diabetes; now the disparity seems to be increasing

Annual diabetes death rates per 100,000 people, for diabetes as a multiple cause of death and for diabetes as an underlying cause of death. (Mayo Clinic graph from Centers for Disease Control data; click on it for a larger version)

Diabetes comes with lifelong care and an extensive list of possible complications, which range from eye problems to foot problems to kidney problems, gum disease and cancer. A Mayo Clinic study has found that rural counties have higher diabetes death rates, and the disparity seems to be increasing. "The researchers point out that these rural health trends would not be visible in an analysis of national-level data," the National Institute on Minority Health and Health Disparities reports. "Large declines in diabetes mortality in recent decades in more urbanized counties have resulted in national-level declines in ADMR, masking the health disparities present in rural counties."

NIMHS reports, "Using data from the Centers for Disease Control and Prevention, researchers compared the annual diabetes mortality rate per 100,000 people in 2017-2018 with the rate in 1999-2000. This mortality rate includes deaths where diabetes is listed as one of multiple causes." Rural death rates rose slightly, but fell in urbanized counties, "showing that people in rural areas were not experiencing whatever factor accounted for the decrease in more urbanized areas. . . . Rural health disparities in diabetes were a consistent theme across all groups."

While the study showed that rural people are more likely to die from diabetes, it did not isolate causes. "The researchers suggest several possible reasons why people in rural areas may be more likely to die from diabetes. People in rural areas may be more likely to have other medical conditions that could make their diabetes worse. They may have difficulty accessing health care and may not consume as many fruits and vegetables as people in urban areas do. They may also be disproportionately affected by environmental pollution," NIMHS reports. "The researchers write that further research could show why these disparities exist and support development of ways to improve rural health."

The study, "Assessment of disparities in diabetes mortality in adults in U.S. rural vs. non-rural counties, 1999-2018," was published in JAMA Network Open, a publication of the American Medical Association.

Pandemic roundup: Seniors, diabetics, and loved ones left behind reflect on disease that has killed 1 million in U.S.

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

Older Americans reflect on what the pandemic has taken from them. Read more here.

According to the Centers for Disease Control and Prevention, 87% of U.S. children who were hospitalized with Covid-19 during the Omicron surge were unvaccinated. Read more here.

The long-term consequences of the coronavirus pandemic are starting to become clearer, writes the former editor of DTN/The Progressive Farmer. Read more here.

The U.S. death toll from Covid-19 will soon surpass 1 million if it hasn't already. The Atlantic's Ed Yong writes about how many Americans who have lost someone feel their grief has been "intensified, prolonged, and even denied by the politics of the pandemic." Read more here.

Kaiser Health News takes a snapshot of a rural Pennsylvania county with one of the highest Covid-19 death rates in the nation. Read more here.

Diabetics have been one of the hardest-hit groups by the coronavirus. Experts hope policymakers will notice and increase efforts to address the nation's diabetes crisis. Read more here.

The Food and Drug Administration has authorized the first breath test to detect the coronavirus. Read more here.

The recent ruling that vacated the Biden administration's mask mandate for public transportation has dealt another blow to the dozens of small mask factories scattered across the country. Read more here.

Pandemic roundup: Funeral aides weary; rural telehealth overview; stressed rural EMT knows all his passengers . . .

Here's a roundup of recent news about the pandemic and immunization efforts:

Many hospital workers try to get out of vaccination by claiming a religious exemption, saying it's wrong to take a vaccine developed with a cell line that began with a fetus aborted in the 1960s. In an attempt to fight vaccine misinformation, an Arkansas hospital system now requires staff to swear off common medications such as Tylenol in order to get a religious exemption. That's because those medications were also developed using fetal cell lines. In related news, a Texas megachurch preacher and Trump devotee said this week that there is no "credible religious argument" against getting the coronavirus vaccination. The head of the nation's largest Baptist seminary, a leading conservative, says likewise.

As Arizona's biggest hospitals fill with Covid-19 patients, small-town doctors say it's increasingly difficult to find beds there for critical rural patients. Oregon hospitals are so stretched thin that they've been forced to postpone surgeries and cancer care.

In 2020, Covid-stricken Alabama recorded more deaths than births for the first time in its recorded history. Read more here.

Mississippi has seen a surge in the frequency and intensity of new pediatric diabetes cases during the pandemic (both Type I and Type II). The pandemic could be at fault for a number of reasons, they say. Read more here.

Six of Kentucky's rural counties are in the top 10 nationwide for coronavirus infection rates. Health-care providers in a small-town Kentucky clinic share what that surge looks like on the ground. And a paramedic in rural Kentucky says work has been especially tough because he personally knows every Covid patient he's had to transport to the hospital. Meanwhile, some Kentucky hospitals, mostly the larger regional ones, have begun firing staff who refuse the coronavirus vaccine; others haven't, possibly for fear of staffing shortages.

Health-care workers aren't immune to Covid misinformation, and many have refused to get vaccinated, especially in rural areas. Health-care providers in rural Colorado worry vaccine mandates will create staffing problems. Another cause of rural hospital staffing shortages: RNs are being lured away by high-paying traveling nurse jobs.

It's well-known that the pandemic is taxing health-care workers, but funeral professionals are also having a hard time keeping up with increased demand. A Texas embalmer shares what it's like. Read more here.

Here's an overview of the state of rural telehealth during the pandemic, what the federal government is doing to help it expand, and challenges rural health-care providers face in implementing it. Patients and doctors who embraced telehealth during the pandemic worry it will become harder to access. Read more here and here.

Study: the more rural a place is, the higher the incidence of stroke risk factors, especially smoking among the poor

It's well-known that rural residents are at a higher risk of stroke. But a newly published study in The Journal of Rural Health examined the trend across rurality and found that, the more rural the place, the higher the prevalence of stroke risk factors such as hypertension, diabetes, heart disease, smoking, poverty, and more. Most interestingly, the study uncovered a link between stroke incidence and higher smoking rates, especially in poorer areas. 

Previous research has found that more rural areas have higher stroke mortality rates than more densely populated areas, but that's mainly because of a higher stroke incidence, not a higher case fatality, the authors write.

That said, health-care access disparities also worsen rural stroke survival rates, a 2020 study found. Small, rural hospitals often can't quickly transfer stroke patients to bigger hospitals with access to more experienced specialists and newer treatments, according to the study. 

Going to daylight saving time this weekend could be especially hard because of pandemic-related sleep loss

"The clock springs forward one hour on Sunday morning, March 14 for most people in the U.S. That is not an appealing thought for those who have suffered sleep problems because of the pandemic," Michael Jaffee writes for The Conversation. "Sleep this past year has been affected by a variety of factors, including anxiety, inconsistent schedules and increased screen time. This affects our health, as getting adequate sleep is important to assure our immune system can fend off and fight infections. Even before the pandemic, about 40% of adults – 50 to 70 million Americans – got less than the recommended minimum seven hours per night."

Scientists are increasingly concerned about how the twice-yearly time change affects people's bodies. "The American Academy of Sleep Medicine, the largest scientific organization that studies sleep, in October 2020 suggested nixing daylight saving time and moving to a year-round fixed time," Jaffee reports. "That way, our internal circadian clocks would not be misaligned for half the year. And it would eliminate the safety risk from sleep loss when transitioning to daylight saving time."

Jaffee, the vice chair of neurology ay the University of Florida, has studied how the lack of sleep can impair the brain, and believes we have cause for concern: "In the 1940s, most American adults averaged 7.9 hours of sleep a night. Today, it’s only 6.9 hours. To put it another way: In 1942, 84% of us got the recommended seven to nine hours; in 2013, it was 59%. To break it down further, a January 2018 study from Fitbit reported that men got even less sleep per night than women, about 6.5 hours."

Lack of adequate sleep can cause more problems than being tired, Jaffee reports. It's associated with higher rates of heart disease, diabetes, obesity, asthma, depression, and lowered memory retention, attentiveness, and ability to fight off infections.

"States advocating for permanent daylight saving time are typically those that rely on tourism," Jaffee reports. "Environmentalists, favoring less energy consumption from morning heating and evening air conditioning, often support permanent standard time. Religious groups, whose prayer times are linked to sundown and sunrise, also tend to prefer permanent standard time. So do many educators, opposed to transporting children to school during mornings when it’s still dark."

Index shows counties most vulnerable to covid-19 due to underlying health issues; many of them are rural

Covid-19 health risk by county, compared to the national average. New York Times map; click on the image to enlarge it.

Many areas of the U.S. that haven't yet seen major pandemic outbreaks could still be hard-hit in the coming months because of higher chronic health issues like obesity, diabetes, high blood pressure, and other ailments. Many of those counties, are rural.

"Large parts of the South and Appalachia are especially vulnerable, according to a health-risk index created for The New York Times by PolicyMap, a company that analyzes local health data," Nadja Popovich, Anjali Singhvi, and Matthew Conlen report for the Times. "The index for the first time identifies counties with high rates of the underlying conditions that increase residents’ risk of becoming severely ill if they are infected with the coronavirus. Even in lower-risk counties, a significant proportion of the population is living with these conditions."

The index's top 11 highest-risk counties where coronavirus cases are growing are all in rural, heavily African American counties in the Black Belt and the Mississippi Delta. Among them, Dallas County, Alabama, has the highest population, at about 44,000.

New covid-19 risk assessment identifies vulnerable rural areas by degree; see county-level data

Covid-19 relative risk factor scores by quintile of population at risk. (Iowa State University map; click on it to enlarge.)

Without widespread testing for the novel coronavirus, rural counties could appear to be at far less risk of a local outbreak than they actually are, especially in towns of 5,000 to 10,000, according to a new report from Iowa State University’s Extension and Outreach. "The missing data could put rural counties at risk of lowering their guard while the epidemic spreads across the country," Jan Pytalski writes for The Daily Yonder.

The ISU report says, "An outbreak of five severe cases requiring ICU hospitalization in a rural county will far outstrip local resources, but not make national headlines. There is a danger that needed resources will not flow to rural places if decisions are based on absolute counts instead of relative risk." The report's risk scores are in quintiles, or five divisions of 20 percentage points each.

The report posits that rural areas face higher and different risks of serious pandemic outcomes than urban areas, Pytalski reports. The researchers propose assessing rural risk based on 10 indicators grouped in seven components: population, density, percentage of the population living in institutional settings, percentage of seniors (age 65-84) and elders (age 85 and up), employment in elderly care facilities per 10,000 people, mortality rate for immunocompromised people per 100,000, mortality rate from diabetes, and the mortality rate from influenza and pneumonia.

The study is an interesting contrast to another recent project that estimated county-level pandemic preparedness. See it here.

Low-carb diet advocates aims to alter feds' nutrition advice

A group of people who advocate low-carbohydrate diets is trying to persuade the federal government to lower the recommended daily intake of "carbs." The Department of Agriculture and the Department of Health and Human Services are set to update federal nutrition advice in 2020.

"The Low-Carb Action Network — launched on Wednesday by a small group of doctors, researchers and consumers . . . said scientific research shows the diet can help prevent diseases, particularly Type 2 diabetes, and should be included in the Dietary Guidelines for Americans," Ryan McCrimmon reports for Politico's Morning Agriculture. "The network does not receive funding from industry and plans to set up a donation page on its website to raise money, a spokesperson said."

Nutrition guidelines are updated every five years, based on a scientific report from an independent 20-member committee. The guidelines shape federal nutrition programs like school meals and the Women, Infants and Children nutrition program, McCrimmon reports.

"The committee last year signaled it would review low-carb (and high-fat) diets, a move welcomed by a disparate group of nutrition experts, Atkins and keto followers, and the livestock sector," McCrimmon reports. "The research on low-carb diets that the advisory committee includes in its review is a top concern among the leaders of the Low-Carb Action Network."

Proponents of low-carb diets say they're a good way to lose weight and can help reverse and prevent diseases. The American Diabetes Association seemed to support this view with a report earlier this year saying low-carb diets have been shown to reduce the need for diabetes medication, McCrimmon reports. However, some nutrition experts say the long-term health impacts of low-carb diets are unclear and that research on them is so new that it's too early to base firm recommendations on it.

Rural doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing five
pounds of body fat. (Clinton County News photo)

A doctor and a pharmacist in rural Albany, Kentucky are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News notes.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinnier, we want them to be healthy and live longer."

Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties.

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County, Kentucky
(Wikipedia maps)

The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories," such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," Peddicord said.

Diabetes is less deadly than it once was, but improvement in rural areas has faded in recent years

Diabetes mortality over time by rurality. The study grouped categories according to the National Center for Health Statistics' system. (Texas A&M chart; click the image to enlarge it.)

"The life expectancy of Americans with diabetes is diverging based on geography, with metropolitan areas seeing improvement in mortality rates while rural areas do not," Tim Marema reports for The Daily Yonder. That's according to a recently published study by researchers from the Southwest Rural Health Research Center at Texas A&M's School of Public Health.

Rates for diabetes mortality were very similar in rural and urban areas as recently as 1999, but urban areas have improved since then. Rural areas, especially in the South, have seen little improvement though. "From 1999 to 2016, diabetes mortality rates improved by 5.1 points in the central counties of metros larger than 1 million residents. In 'non-core' counties – the most 'rural' category in the study – the mortality rate improved by only 0.85 points during the same period," Marema reports.

The decline in diabetes mortality wasn't because fewer people have the disease; diabetes mortality declined in some areas where the incidence of diabetes remains high. "Possible causes are advancements in diabetes treatment or education, which may have been adopted at different rates in different regions," Marema reports. "The study also said future research should look at the possible roles played by the Affordable Care Act or Medicare Part D, the prescription drug benefit that went into effect in 2006."

Diabetes is disproportionately rural; in last 2 decades rates have declined across U.S., except in the the rural South

Mortality rates from diabetes have improved in most of the country over the past 20 years, but have remained almost unchanged in the rural South, according to a newly published study from the School of Public Health at Texas A&M University.

As the seventh-highest cause of death in the nation, diabetes continues to be a significant health challenge in the U.S. "Rural Healthy People 2020," a decade-long report of rural health goals published by the university, identifies diabetes as the third most important public health issue in rural areas, where diagnosis rates can be as much as 17 percent higher than in cities and suburbs. As of 2015, 30 million Americans have diabetes and another 84 million were pre-diabetic, Rae Lynn Mitchell reports for Texas A&M's health news publication.

The study's lead researcher, Assistant Professor Timothy Callaghan, told Mitchell that diabetes is most likely more common in rural areas because of a lack of education about it, different training for health-care professionals, and/or lack of access to care. He cautioned that the study does not establish cause and effect.

The research studied publicly available data from the National Center for Health Statistics and the Centers for Disease Control and Prevention from 1999 to 2016.

Some rural patients could lack access to dialysis after non-emergency ambulance reimbursement cut takes effect

Rural dialysis patients could lose access to treatment when a 13 percent cut in Medicaid and Medicare reimbursement for non-emergency ambulance transportation goes into effect Oct. 1.

The cut was included in the continuing resolution Congress passed in February. It comes on top of a 10 percent cut mandated in 2013, which means the reimbursement for such ambulance rides will be 23 percent less than five years earlier.

Virgil Dickson reports for Modern Healthcare, "Transportation for dialysis patients can mean the difference between life and death for some, as many aren't able to drive or don't own cars, according to Alice Andors, a spokeswoman for the American Kidney Fund, a charity dedicated to helping kidney patients pay their insurance costs."

Health-care providers may no longer be able to afford to send ambulances on dialysis runs. John Watts, CEO of South Carolina ambulance provider MedTrust, said his company can't afford to provide dialysis transportation, and said rural patients with no other options will likely suffer. Joyce Noles with West Tennessee Healthcare told Dickson that the company may start using stretcher vans for dialysis rides, which would mean that patients who experience a medical problem during transit would not have a medical professional present to help.

As we reported yesterday, Type 2 diabetes is a major health concern in rural America, and rural residents are already at an increased risk of dying from diabetes-related hospitalizations.

Diabetes hospital deaths more likely for rural residents

Type 2 diabetes is a big cause for concern in rural America, especially in the South and Midwest, according to a study by the Southwest Rural Health Research Center at Texas A&M University. The study, funded by the federal Health Resources and Services Administration, found that despite innovations and increasingly available self-management programs, big differences between rural and urban death rates remain: rural residents are 17 percent more likely to die from a diabetes-related hospitalization than people who live in large metropolitan areas.

More than 30 million adults, about 10 percent of the population, have diabetes; 97 percent of them have Type 2 diabetes. It's the seventh most common cause of death in the country, with nearly 80,000 related deaths in 2015. This study focused on diabetes deaths in hospitals in 2009-2014. Of the 38,075 diabetes-related deaths in hospitals, 20.3 percent occurred in rural areas. Death rates were highest in rural areas of the South and Midwest (21.0 and 15.1 per 100,000 population, respectively) compared to the Northeast and West (11.1 and 10.8, respectively). Nationally, a rural-urban difference of 3.4 percentage points amounted to a 17 percent difference in rural and urban rates.

The researchers speculated that the difference in death rates could be attributed to factors such as access to primary and endocrinology care, health literacy, trust in the health-care system, access to good nutrition, and lifestyle choices. They recommend that more research be done to explore the role of these factors in mortality discrepancies. 

Health bill's potential waiver for coverage of pre-existing conditions would hit areas Trump won

The health bill passed on Thursday by the House would make insurance more costly for pre-existing conditions, which are more common in the South and Midwest, areas where President Trump was the most popular, Max Ehrenfreund reports for The Washington Post. Pre-existing conditions include obesity, heart disease, diabetes, cancers and Alzheimer's disease. According to the Kaiser Family Foundation, at least 30 percent of the population has pre-existing conditions in 12 states won by Trump—Alabama, Arkansas, Georgia, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and West Virginia. (Post graphic: Where Americans have the most pre-existing conditions)

"Obamacare generally requires insurers to charge all their customers comparable prices, with rates varying only by their ages, where they live and whether they smoke," Ehrenfreund writes. "Under the Republican proposal, states could get exemptions from those rules by requesting a federal wavier. Insurers operating in those states could ask potential customers to provide information about their health and charge them different rates based on their answers — although insurers could only charge more for those customers who previously allowed their health insurance to lapse for at least three months."

"It is difficult to tell how many people could pay more if the Republican bill becomes law," Ehrenfreund notes. "If states did not try to waive the rules, patients would continue to have some protections.The insurance lobby would probably urge state officials to ask for waivers, because screening out the sickest applicants would allow insurers to bring down their costs. Advocates for patients and public health would oppose waivers, and if those groups prove to be politically weaker in red states, then it would be more likely that consumers with preexisting conditions in those states would pay more."