By Dave Gardner
One of the common health scourges of Northeast Pennsylvania apparently is largely related to diet and lifestyle more than most regional residents care to believe.
Diabetes, the disease caused by a malfunction of the pancreas, results when that organ decreases in its ability to produce or respond to the hormone insulin. This results in abnormal metabolism of carbohydrates and elevated levels of sugary glucose in the blood and urine.
A classic symptom of diabetes is increased urine output, but the disease can often be silent, especially in its early stages when symptoms may not be obvious. Inevitably, unchecked diabetes can result in damage to the eyes, kidneys, nerves and heart, with patients potentially losing a limb.
According to the American Diabetes Association, a 2012 study revealed that total costs of diagnosed diabetes have risen to $245 billion in 2012 from $174 billion in 2007, with no end to the increases in sight. This indicates a 41 percent rise in care costs over a five-year period.
Alfred Casale, M.D., associate chief medical officer and chair of the Geisinger Heart Institute, explained that diabetes usually is either Type I or Type II. Type I typically displays as juvenile onset due to inherited pancreas problems, while Type II often has an adult onset and is related to obesity.
“It is the Type II that responds to weight loss and exercise, but in its later stage requires medications,” said Dr. Casale. “When a discovery is made of a patient having pre-diabetic high sugar, it often can be managed with lifestyle changes, with medication only used later.”
The risk factors for Type II diabetes are well known, despite the prevalence of American obesity. Patient behavior affects healthy outcomes, and self-inflicted risk through poor diet and sedentary behavior must be acknowledged.
According to Dr. Casale, the best prescription for Type II diabetes is to modify eating habits and include more fresh food. Simple and modest exercise measures such as walking in a parking lot or taking stairs consistently can lead to significant improvements in patient body mass and resultant sugar levels, even if age and arthritis are deterring activity.
“To avoid Type II diabetes, extremist attitudes are outdated because they can’t be sustained,” said Dr. Casale. “This all is not rocket science, and prevention is always the best approach.”
Patient and physician interaction to create compliance with diet and exercise goals is also a factor in management of Type II. Dr. Casale explained that brow beating a patient simply doesn’t work, but a physician who uses a cheerleader approach and includes an educational component may achieve results.
The physician must be clear with the diabetic patient about what is happening to his or her health, and only moderate and reachable goals should be set. The obese patient also should be enlightened that the unhealthy behavior will eventually affect more than just them.
“I urge patients to improve their diet and lifestyle for their kids, spouse and grandchildren,” said Dr. Casale. “Yes, there is illogical thinking about wellness out there, but most patients do understand risk versus benefits.”
A major factor in NEPA’s obesity epidemic and its predictable relationship with Type II diabetes is the region’s love of alcohol. While alcohol does not attack the pancreas directly, it comprises empty calories in large quantities that inevitably add mass to a user’s body.
“A male should never have more than seven to 10 drinks a week, and for a female it’s 20 percent less,” said Dr. Casale. “If a person is consuming more alcohol than this, they should consider enlisting a partner to help with behavioral therapy.”
The ratio of Type I to Type II diabetes within NEPA is about 50/50, according to Jignesh Sheth, M.D., senior vice president of clinical operations with The Wright Center for Graduate Medical Education. He agreed that obesity and sedentary behavior are fueling the onset of Type II diabetes, and that the nation’s informational resources directed against Type II are low in proportion to the problems caused by the disease.
“When secondary disease already exists, the goal must be to prevent complications,” said Dr. Sheth. “This is a problem, because prevention should be the primary goal.”
A national Type II prevention program, according to Dr. Sheth, would involve high-level policy changes throughout American society with the goal of controlling obesity. Healthy food programs that start at the basic school level, and add physical activity, should be widespread.
The workplace also has a role. Employers could readily offer health metric incentives with insurance costs, along with discount gym memberships or the use of on-site exercise facilities.
This would be in direct opposition to NEPA’s sedentary “casino culture,” love of red meat, use of alcohol and overall bad food habits. Encouragement to consume a plant-based diet, as opposed to a meat-based nutrition, could create dramatic results toward prevention of diabetes.
“Many of NEPA’s bad food habits are cultural, and they still exist because of the region’s overall lack of young lifestyle adults,” said Dr. Sheth. “In addition, many jobs in NEPA are not activity based and many workers and students put in very long hours, leaving little time or energy for an active lifestyle.”
Early diagnosis is vital for diabetes treatment, and Dr. Sheth advocates annual screenings of baseline blood levels. A long list of oral medications is now available for physicians to prescribe if needed, plus insulin which is now available in discrete pen injectors.
“I don’t see a single patient who can’t be controlled, even if they have Type I and we use an insulin pump,” said Dr. Sheth. “When the diabetes has a genetic connection, medication is particularly useful, and I also have seen impressive results with weight loss from bariatric surgery procedures.”