Increase awareness and life style change weight loss programs to reverse the metabolic cause of Type II Diabetes

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Let’s raise the bar and not accept Type II Diabetes (TIIDM) as a lifelong disease.   Life style change interventions have been shown to prevent TIIDM in pre-diabetics and control and decrease severity of disease people with TIIDM.

The CDC estimates that 23.6 millions Americans have diabetes and 90-95% of whom have TIIDM.

Racial and ethnic minorities suffer more TIIDM, higher mortality and morbidity rates and are more likely to live where access to healthy food and physical activity choices are limited.

The costs of diabetes are estimated to triple in the next 25 years.  The medical expenditures for a person with diabetes are 2.3 higher than the expenditures for a non-diabetic.

TIIDM is a disease of abnormal metabolism when the body becomes resistant to Insulin which helps the body use food energy.  The cause of the metabolic abnormality is excess fat.   The TIIDM treatment goal is blood glucose control, often with medication, to delay and prevent organ system damage.

When we know that a metabolic disease has a potentially reversible cause shouldn’t patient care emphasize reversal along with metabolic control?  If a tumor was the cause wouldn’t we get rid of the tumor?

Lifestyle change, especially weight loss, is difficult.  But compare that to a lifetime of daily medication, finger sticks, multiple doctors visits, medical tests and potentially renal failure, heart failure, blindness and amputation.  Don’t we have an obligation to fully disclose, educate and assist in the lifestyle changes that are critical to reverse the causal metabolic abnormality that leads to suffering?

Group lifestyle change interventions have been studied and are being implemented in community settings in New York City and Minnesota.   Below is an example of a group program in a Diabetic Rehabilitation program in Copenhagen.
Copenhagen Diabetic Rehab Program Outline

The growing numbers of people in the US suffering from TIIDM and the finite nature of US Health Care funding are both equally compelling reasons to invest in helping reverse TIIDM as much as possible.

The TIDDM message, clinical and educational energy and funding need to be changed to better emphasize and implement group lifestyle change  programs especially in community based settings and disadvantaged areas.

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3 Responses to “Increase awareness and life style change weight loss programs to reverse the metabolic cause of Type II Diabetes”

  1. nonahezema Says:

    As a family physician serving a large T2DM population, I do appreciate the concerns raised here.
    Another aspect of the problem is that many of these patients are from low income families living in poor neighborhoods with limited access to almost everything good. Many times they have the desire to make the necessary changes but they lack the capacity and resources to carry it out. Their overall social, economic and physical environment is just not supportive of healthier lifestyle options.
    There is an urgent need for a broad based policy that will address such issues as educational and employment opportunuties, access to healthcare, food security, more secure neighborhoods and a built environment that promotes physical activity.
    I am afraid that just teaching them the importance of healthier lifestyle options without addressing these other enabling factors will yeild only very limited results.

    • mernabrownie Says:

      So true. Studies have shown that giving diabetics knowledge is not enough to change behavior. It is not just education it is interventional training. My vision of a program is that it is community based and at least in part community run. As a community, they should or at least could come together to put pressure on the commerce in the community to offer healthy food options. Going out to walk together may be more motivating, especially in less that than safe neighborhoods. Dancing is great exercise and may be an alternative with more appeal. The support and unity would be empowering for the individual and group.

  2. stoicaa Says:

    Enhancement of adopting healthy lifestyle is extremely important since currently there is a huge increase (~75%) in TIIDM not only in adults (especially in 30-40 years of age), but also in overweight children. The etiology of this multifactorial disease has not been totally elucidated and several risk factors are not known yet. However, overweight and obesity are strongly associated with development of the disease.
    While fasting glucose is heritable by race/ethnicity and genetic differences were observed in insulin secretion/response and seversl differences in lipids and lipoproteins exist by race/ethnicity, the obesogenic environment in the U.S. (abundance of foods and sedentary lifestyle) is mostly responsible for this major health problem. Therefore, group lifestyle change programs in community-based settings are very important strategies and may work for certain groups of people in certain neighborhoods.
    Dietary interventions, however are effective only if healthy foods are accessible and affordable, clearly a problem in disadvantaged areas. As long as minorities continue to face challenges accessing affordable healthy foods, together with limited excercise opportunities due to unsafe neighborhoods, it will be difficult to fight the racial/ethnic disparities in TIIDM. Policies for food assistance access, break-down of enrollment barriers to intervention programs, and culturally-competent nutrition counseling are needed in parallel with healthy lifestyle changes for ensuring that minorities’ households can enhance their health.

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