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The primary objective of this study was to determine the self-reported prevalence rates of diabetes mellitus, heart disease, and stroke in a region of Appalachian Ohio. A secondary objective was to determine the prevalence of specific cardiovascular risk factors and impact of certain socioeconomic factors which might contribute to this increased risk. --A total of 2,350 telephone surveys were randomly conducted with a minimum of 300 surveys from each of seven southeastern Ohio counties. The survey was based on the 2004 Behavioral Risk Factor Surveillance System survey (BRFSS) from the Centers for Disease Control and Prevention (CDC). Data collected in these counties was then compared to aggregate Ohio and national data from the 2004 BRFSS survey. --Self-reported prevalence rates of diabetes mellitus (11.3%), heart disease (7.6%), and stroke (4.1%) in Appalachian Ohio (ARHI) are much higher than Ohio or national 2004 BRFSS rates. Each county surveyed exhibited prevalence rates of diabetes, heart disease, and stroke/TIA which were nearly 40% greater than Ohio and national 2004 BRFSS data. The onset of diabetes also occurrs at a younger age as 13% indicated that they developed diabetes before the age of 20 in Appalachian Ohio which is more than twice Ohio (5.7%) and national (5.2%) BRFSS data. Presance of cardiovascular risk factors were slightly higher in this region though not statistically significant. Among persons with diabetes, lower income, a poor perception of personal health status, and increasing BMI were associated with increased risk for diabetes and atherosclerosis. Cost/inadequate access to diabetes-related medications and self-monitoring supplies were significant barriers to appropriate care in this region. --Self-reported prevalence rates of diabetes mellitus, heart disease and stroke in Appalachian Ohio are much higher than aggregate Ohio and national 2000 BRFSS data. Lower socioeconomic status contributes to this increased risk while decreased access to medications and glucose testing supplies contributes to poorer outcomes. [ABSTRACT FROM AUTHOR]

Context: The diabetes pandemic has outpaced the US supply of diabetes specialists and has overwhelmed primary care providers (physicians, physician assistants, and nurse practitioners). Primary care diabetes fellowships can be used to address this workforce shortage., Objectives: To determine the skills obtained during 2 diabetes fellowship programs, the barriers encountered in practice, the impact of the programs on career paths, and perceived acceptance by patients and colleagues., Methods: A Qualtrics link to a 26-item survey was sent via email to all graduates of the Ohio University Heritage College of Osteopathic Medicine and East Carolina University Brody School of Medicine diabetes fellowship programs. Items included demographic information, comfort level with different clinical diabetes skills, and current system barriers encountered in their practices., Results: Of 39 graduates, 36 completed the survey. The most beneficial skills acquired during the fellowship were insulin pump management (13 [36%]), insulin management (10 [29%]), and diabetes pharmacology (6 [17%]). The most common barrier was the lack of board certification as a diabetologist, which affected time with patients and insurance reimbursement. The perceived acceptance by patients was high (25 [69%]), and the perceived receptiveness by colleagues was mostly neutral (7 [19%]) or positive (10 [29%]). The most common postfellowship career path was primary care medicine (15) followed by hospitalist (7) and diabetologist (5)., Conclusion: Physicians who completed the diabetes fellowship training reported high comfort levels with treating patients with diabetes, but they also reported the barriers faced in an unrecognized specialty.