Research Communications

Sugar Stories 

From comic books to community dialogue, diabetes educators use creative communication in Appalachia

May 31, 2011

In Appalachia, everyone knows someone who’s been diagnosed with “sugar,” or type 2 diabetes. The prevalence of the disease is 33 percent higher than the national average in this often rural, disadvantaged region of the United States.

Sharon Denham, an emeritus professor of nursing at Ohio University, was part of the team of Centers for Disease Control (CDC) researchers that discovered this alarming statistic. In the last several years, she’s been working to combat the problem by developing a series of public education and outreach programs called “Diabetes: A Family Matter,” that address the specific cultural and socioeconomic needs of people with type 2 diabetes, their families, and communities in this region.

Diabetes Book
Images shot by Ohio University Assistant Professor Larry Hamel-Lambert help illustrate the daily struggles of people diagnosed with type 2 diabetes.

With funding from the CDC, Denham launched The SUGAR (Support to Unite Generations in the Appalachian Region) Helpers program, which trains community volunteers to provide educational materials and create a dialogue in their neighborhoods, churches, and schools about prevention and treatment of diabetes.
The program complements the work of health care providers, who may not have the time, expertise, or numbers to provide such outreach, Denham says.

The Helpers are equipped with a series of informational brochures that not only debunk common myths about diabetes—you can’t eat sweets; there’s little patients can do to care for the condition—but provide stories and photos of real Appalachian families struggling with the illness.

“I think we’re making a difference because it’s really something culturally sensitive—the people in the materials look like people they know,” Denham says.

Some of the materials read like comic books, telling familiar stories about newly diagnosed diabetes patients who struggle to adopt healthy lifestyles. The tales illustrate the personal and social pressures these individuals face when family members still expect fried foods to be prepared for dinner or sugary cakes baked for the church potluck.

Sharon Denham
Sharon Denham.

Denham’s outreach also includes a 35-minute documentary film called “Living with Diabetes in Appalachia” by Athens videographer Steve Fetsch, photo documentaries by Assistant Professor of Visual Communication Larry Hamel-Lambert, and a series of plays that students of Distinguished Professor of Theater Charles Smith have penned to tell more real-life tales of the struggle of living with diabetes and the journey to wellness. Much of the material is available on Denham’s website,

The CDC now has awarded $2.5 million to Denham and colleagues to expand the diabetes prevention and education program to 11 rural counties in five states (Ohio, Kentucky, West Virginia, Virginia, and Mississippi.) The project aims to build strong, sustainable diabetes coalition groups that will examine behaviors, policies, and environments in an effort to make positive changes in the health of residents, she says. Partners are the Center for Appalachian Philanthropy, a non-profit group in Portsmouth, Ohio, Lesli Johnson and Laura Milazzo of the Ohio University Voinovich School of Leadership and Public Affairs, and Richard Crespo of Marshall University.

The need for diabetes outreach is crucial, Denham adds, as studies project that, without intervention, up to 50 percent of the Appalachian population could be diagnosed with type 2 diabetes in the upcoming years.

“If we reduce diabetes risks and the numbers of people with type 2 diabetes, we will impact other health conditions such as heart attacks, strokes, high blood pressure and cholesterol, cancer, and other diseases,” she says. “We also can reduce complications such as blindness, kidney disease, and nerve disease.”

By Andrea Gibson

This article appears in the Spring/Summer 2011 issue of Perspectives magazine.