Milton and Leona Scott, both in their late 50s, normally don't spend time at the Four Seasons Hotel adjacent to Lumiere Place Casino in downtown St. Louis. But they were among 250 people who gathered in the hotel's elegant ballroom one Saturday morning last April to learn more about coping with and combating diabetes.

Hosting a free diabetes education program at a 5-diamond hotel may seem unusual, but it's just one of the ways the St. Louis Diabetes Coalition is taking its message out of doctors' offices and to the public. The group also is taking diabetes education to many community-gathering spots, such as churches and coffee shops.

Joan McGinnis, the coalition's director of education, called the hotel "a lovely environment" for the event, which featured a speech by a diabetes educator, questions from the audience and strategies for managing the disease.

McGinnis was particularly elated when hearing that participants, such as the Scotts, learned new things about diabetes even though many have suffered from the disease for several years. Leona Scott appreciated that the group passed out small, magnetic squares, each containing a picture of a food and information on the safe number of grams of carbohydrates a diabetic should consume from the food. Though Scott understands the connection between carbohydrates and her diabetes, she said the magnetic squares made her realize there was an easier and more convenient way to keep track of how many carbs she was consuming.

Like the cost of using the hotel site, the material distributed at the session was underwritten in part by Accu-Chek, which makes devices to help consumers test for diabetes. People with diabetes are supposed to consume roughly 60 grams of carbohydrates during each meal.

"One of the problems is that people don't think in terms of serving sizes," McGinnis says. "We need to start with carb counting because people don't understand the concept."

Restaurant serving sizes have increased over the years creating a greater problem.

"Bagels, for example, are larger now," she says. "What you're getting now may be twice the size of what you need, and many contain at least two to three times more grams of carbohydrates than you need."

The coalition is working with Saint Louis University's Center for Outcome Research to broaden the reach of diabetes education. The idea is to empower consumers to make more informed decisions about eating healthy food, being responsible with medications, getting sufficient exercise and communicating with health care providers.

'an Explosion of Diabetes'

The coalition's programs are free and open to everyone, but the group is especially interested in reaching people who are clueless about how best to handle a disease that's claiming more victims as Americans get less or no exercise and eat more unhealthy foods.

"There has been an explosion of diabetes," says McGinnis. "Even children are getting Type 2 diabetes at age 10 to 14. It used to be that people would get (Type 2) diabetes when they were in their 40s."

According to the coalition, nearly one in five St. Louisans older than 55 has Type 2 diabetes. African-Americans who are 50 or older are at the highest risk. The diabetes mortality rate for blacks in St. Louis is 51.1 for every 100,000 people, and the white rate is 27.6 for every 100,000.

Even so, those numbers may understate the severity of the problem in many black neighborhoods. For example, in the 63113 zip code, the Ville community where the Scotts live, the rate is 61.8 for every 100,000. The rate in the adjacent 63106 zip code is perhaps the highest in the city -- 71.9 for every 100,000 residents. Several other north side zip codes where the mortality rates are quite high include 63107 (55.6); 63147 (53.5); and 63115 (55.1).

These numbers bring added urgency to the coalition's work. They also offer hope to diabetes educators and diabetics themselves of getting a handle on the problem. The coalition points to research showing that diabetics live healthier and better quality lives when they are taught to manage the disease.

The coalition's work with SLU's Center for Outcome Research is financed by a $99,000 grant from the St. Louis Community/University Health Research Partnership. Set up in 2009, the partnership focuses on research into diabetes and other health problems. The partnership, assisted by the Regional Health Commission, is supported by $1.5 million in funds from SLU, Washington University, and BJC HealthCare. The Missouri Foundation for Health also helps to finance other area initiatives to fight diabetes.

Thomas Burroughs, principal investigator for the partnership's program, says the diabetes outreach project "dives into self-testing blood glucose levels, planning diet and exercise, and communicating honestly and effectively with health-care providers" about diabetes.

Many Have Never Participated

Though Type 2 diabetes is widespread, the partnership says a shortage of education programs prevents many from taking control of their diabetes. The coalition says that 49 percent of St. Louisans with diabetes, or an estimated 75,000 people, have never taken a class to learn how to manage the illness.

In addition, McGinnis points to several barriers that thwart Type 2 diabetics from getting help, including lack of insurance or limited coverage. Others, she says, don't get the education because their jobs prevent them from taking off to participate. She also says some are impeded because they do not get the support and encouragement to understand how diabetes, a chronic disease, can affect their lives.

"We've designed our program to address all of these barriers," she says. "Through this project, experienced diabetes nurse educators and nutritionists will be available to provide individual consultations in convenient nearby locations."

Eric Armbrecht (right), assistant professor of internal medicine and health management and policy at SLU, says the project builds on progress the coalition and others have made in addressing diabetes over the years.

"The coalition has a strong tradition of using new approaches to engage and educate people with diabetes," he says. "We believe our university-community collaboration can be a powerful force in improving the health of St. Louisians with diabetes."

Aside from these issues are others that can make a difference. Public health workers here and nationwide have called attention to how safe sidewalks, parks, reliable public transportation and access to fresh fruits and vegetables can reduce the severity of diabetes.

One study by Amy Auchincloss of Drexel University in Philadelphia showed that people with these options were 38 percent less likely to develop diabetes. Her research covered 2,285 adults, between the ages of 45 and 84, based on information about physical activity, weight, diet and blood sugar levels between 2000 and 2002.

McGinnis also suggests that some of the responsibility should be placed on health-care providers who may not be getting across to patients the importance of diabetes education.

"You have to work with people to help them understand that you need it," she says.

Diabetes education is a way to help patients ask their doctors the right questions.

"A lot of people think of doctors as authoritarian, perhaps," McGinnis says. "You have to ask them what can you do to help yourself improve your diabetes care. A lot of people will not do that."