Although researchers aren’t sure why some people develop type 2 diabetes while others don’t, they do know that certain factors heighten the risk of developing the disease. One primary factor is being overweight or obese (defined as ranges of weight greater than what is generally considered healthy for a given height), according to the Centers for Disease Control and Prevention (CDC). What’s more, carrying around extra padding increases the likelihood of developing not only type 2 diabetes but also related illnesses, such as heart and kidney disease.
“There’s a very strong correlation between type 2 diabetes and obesity in African-American men and especially in our women,” says Anthony Cannon, MD, section chief of endocrinology at the Robert Wood Johnson University Hospital in Hamilton, New Jersey. “African Americans are 1.4 times more likely to be obese than non-Hispanic whites.”
Simply defined, diabetes is a group of diseases marked by high levels of blood sugar (glucose) resulting from defects in insulin production or action. Insulin is a hormone the body needs to convert sugar, starches, and other food into the energy required for its proper daily functions.
There are several types of diabetes, but the two most familiar to people are type 1 and type 2 diabetes.
Type 1 diabetes (a.k.a. juvenile-onset diabetes) usually targets children and young adults, but the disease can occur at any age. It develops when the body’s immune system destroys the insulin-producing cells of the pancreas (called beta cells) that regulate blood glucose. Type 1 diabetes is not preventable. It’s treated with insulin, delivered either with injections or via a pump.
Unlike type 1 diabetes, type 2 diabetes (a.k.a. adult-onset diabetes) is preventable. It usually starts as insulin resistance, a disorder in which the cells do not use insulin properly. As the body’s need for insulin rises, the pancreas eventually loses its ability to produce the hormone. This kind of diabetes is associated with obesity, physical inactivity, a family history of the illness, advancing age, race and a number of other factors. Treatment includes monitoring your blood sugar levels, lifestyle modifications (healthy eating and regular exercise) and possibly drug therapy.
“We now have a class of drugs that allows us to have more tools in our [treatment] toolkit,” Cannon says.
The drug Cannon refers to is Victoza (liraglutide), which the FDA approved earlier this year. Cannon uses it to help his type 2 diabetes patients lower their blood sugar levels and lose weight. Plus there are other benefits, he says. “With the addition of Victoza for weight loss and blood sugar improvements, I’m sometimes able to remove some of the other pills from the patient’s prescribed meds.”
But Cannon doesn’t immediately prescribe this drug for his type 2 diabetes patients. First, he has a certified diabetes educator help his patients make lifestyle modifications with diet and exercise. “I educate my patients and spend a great deal of time with them setting up the foundation of care,” Cannon says. “It always starts with medical nutritional therapy.”
Medical nutritional therapy is based on a detailed assessment of a patient’s medical, psychosocial and dietary histories along with physical examination. But when Cannon’s type 2 diabetes patients don’t respond well to this kind of therapy, he considers drug therapy.
“The medication often starts the [weight loss] process and patients feel better about themselves so they may do more to exercise, eat better, maintain portion control and often lose more weight on their own,” Cannon says.
But other doctors, like Ian Smith, MD, author of The 4 Day Diet and founder of “The 50 Million Pound Challenge,” are fighting diabetes on the prevention front with public awareness and education campaigns.
Smith founded the weight loss initiative in 2007. His goal? To get America to collectively lose 50 million pounds. (At the time of his interview, Smith says the calculator on the campaign’s website had registered almost six million pounds lost so far.)
“We hope to lower people’s blood pressure, prevent strokes, decrease the rate of heart disease in some patients and also help people better manage diabetes through weight loss, exercise and eating better,” Smith says.
When CVS became a sponsor of the campaign, they helped produce a challenge guide with diabetes and weight loss information. The comprehensive booklet, which includes an eating regimen to show people how to eat better, is available in CVS stores. People can sign up for the challenge online and utilize resources available both there and in the stores.
“If you look at the data, African Americans are at the upper end of the spectrum when it comes to obesity and diabetes and high blood pressure,” Smith says. “From a statistical standpoint, we are in greater need of this kind of information and intervention. But the program is for everyone.”
Smith also serves as an ambassador for CVS/pharmacy’s “To Your Health Program.” It is a community health screening program that offers free, comprehensive health risk assessments and screenings in Atlanta, Washington, DC and Philadelphia. The events provide screenings for diabetes, blood pressure, cholesterol, bone density and vision, accompanied by doctor consultations, medication review with a CVS pharmacist, and referrals for mammograms and Pap smears. (Dental and chiropractic screenings are also available in select locations.)
For more information about the challenge, click here. And for more information about the CVS pharmacy program, click here.
Fat Chance
Doctors are educating patients about obesity and its connection to type 2 diabetes onset.
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