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Diabetes Prevention: You CAN Reduce Your Risk
Dr. Tom Elasy, Director of the Center for Diabetes Tranlational Research and Director of the Division of General Internal Medicine and Public Health, talks with Laura Osterman about diabetes prevention.
Laura Osterman: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Laura Osterman with Health Plus. I am here today with Dr. Tom Elasy, director of both the Center for Diabetes Translational Research and the Division of General Internal Medicine and Public Health. Thank you for joining us here today.
Dr. Tom Elasy: Pleased to be with you.
Laura Osterman: What is diabetes?
Dr. Tom Elasy: Diabetes fundamentally is a disturbance of sugar control or what we would call glucose control usually caused either because of a lack of insulin or of an inability of the body to adequately use the insulin that it has. We usually measure the degree of diabetes by looking at a blood sugar level, and we define diabetes as a fasting blood sugar greater than 126 mg/dL.
Laura Osterman: Why is it important for us to focus on preventing diabetes?
Dr. Tom Elasy: Diabetes is a major public health issue, and quite frankly, it is expensive and hard to manage. In particular, the one that I am referring to is type 2 diabetes, and it is important for us to focus on preventing it because it is just so much easier as a nation to prevent the development of diabetes than to have to deal with both management as well as the consequences of diabetes. In addition, it is not just a difficult disease, but it is a disease that is preventable. I think it behooves us as a nation to think and address those things that we can do something about, and there is clear data about how we can go about preventing diabetes, there are concrete things that we can do.
Laura Osterman: What are some of those things that one might do?
Dr. Tom Elasy: A number of years ago, a study was published called the Diabetes Prevention Program or the DPP, and in that study, they looked at both behavioral and pharmaceutical approaches to preventing diabetes, and both worked. Remarkably, sometimes we devalue behavioral change, but in this study, the behavioral efforts were actually superior to the drug efforts. So, individuals who are able to exercise regularly for at least five times a week about 150 minutes or so or could lose about 7% of their body weight were able to decrease the likelihood of developing diabetes by nearly 60% over a 2-1/2- to 3-year period and while behavior was better than drug therapy, drug therapy also worked, not quite as good but still worked. So, there is a medication that is popularly used today for the treatment of diabetes that can also be used for the prevention of diabetes. It is a medicine called metformin, sometimes known as Glucophage for those that pay attention to other names, and that medicine or the implementation of some of those behavioral changes can decrease the likelihood of development of diabetes.
Laura Osterman: How would I know if I am at risk?
Dr. Tom Elasy: Probably, the best way to know that you are at risk is through a blood test. Individuals who get a random blood test for whatever reason, and if you see that the sugar is slightly elevated, remember I told you that the diagnosis of diabetes is a fasting greater than 126. Well, if your sugar fasting is between 100 to 125, we actually have a name for that. We call it prediabetes. So, while the sugar is not normal, it is also not high enough for us to call it diabetes, the normal might be less than 100. So, that’s actually your best clue that you are at risk for developing diabetes; you actually have prediabetes. And it is in that population that we find that when we intervene we have the best results in terms of preventing the development of diabetes. But beyond blood test, we know that there are other risk factors. Again getting back to gestational diabetes, so, if you are a woman and you develop diabetes as a part of your pregnancy, you actually have a risk of up to 1 in 2 over your lifetime of developing diabetes. Certain individuals of non-Northern European descent are at higher risk for diabetes–Hispanics, African American. As you age, you are actually at higher risk for the development of diabetes, and certainly, we have already mentioned a sedentary lifestyle or obesity puts you at risk for diabetes.
Laura Osterman: Any other recommendations you would like to share with our listeners?
Dr. Tom Elasy: Well, we have spoken a lot about the prevention of diabetes. I think it is so important. I mentioned this condition called prediabetes and how it is so important particularly in those individuals. There may be upwards of 50 to 70 million Americans that have prediabetes. So, I really want to emphasize that as part of our conversation. I think the other thing that I would say is there are also 24 to 25 million Americans that have diabetes, and it really is not your grandfather’s disease. It is a disease that we can manage and we can manage well. While it is difficult, it is certainly not insurmountable, and I think with some of the advances in both devices and technology in medications and newer insulins, I am quite frankly hopeful. Both, not just the prevention of diabetes but also for some reason, you develop diabetes. We can take really good care of you today.
Laura Osterman: Any resources recommendations of additional places people might go for information?
Dr. Tom Elasy: Yeah, you bet you. So, I hope it is not self-promoting to talk about our own clinic. We have had a wonderful program, the Vanderbilt Eskind Diabetes Center here on the eighth floor of Medical Center East in the South Tower. It is just a wonderful place, and we are very, very fortunate in middle Tennessee to have a resource like that. But beyond, it is sort of the local area in terms of resources, in terms of reading, the American Diabetes Association is a wonderful resource in particular for type 1 diabetes also. JDRF is a wonderful organization, the Juvenile Diabetes Resource Foundation, and then finally, there is something called the National Diabetes Education Program. If you were to search that term, you would find just a wonderful amount of resources available for education but let me end by promoting my colleagues who are here, the dietitians, the nurses, the physicians that are here who are just wonderful at Vanderbilt in the Eskind Diabetes Center, and it would be privilege to assist in the care of anyone here.
Laura Osterman: Thank you so much for your time today.
Dr. Tom Elasy: It has been my pleasure. Thank you.
Laura Osterman: Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at email@example.com or you can use the “Contact Us” page on our website at healthandwellness.vanderbilt.edu.
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