PREVENTION OF TYPE 2 DIABETES BY LIFESTYLE
NOTHING BEATS LIFESTYLE CHANGES TO PREVENT
AND TREAT TYPE 2 DIABETES IN USA/EUROPE/AUSTRALIA/NEW ZEALAND…etc.
I have just attended a fabulous
professional meeting of the (American) Endocrine Society in Houston, Texas.
Believe it or not, there were 8000 participants, divided among Clinicians and
Researchers.
All the Endocrine systems were covered in
detail.
Race and Culture do matter in metabolic
diseases where there is a huge lifestyle component. While admitting that Type 2
Diabetes is the worst treated disease in the USA, Professor Davidson, was able
to show multiple differences in obesity rate, treatment adherence rate, outcome
rate among various groups of Spanish speaking immigrants and their children,
the so called, “Hispanics”.
Surprisingly, Asian Indians living in
America (belonging to Pakistan, India, Nepal and Bangladesh) had the highest
rate of Type 2 DM of all the residents of the USA! Obesity rate among Asian
Indians born in America is at the same level as the American born
Mexicans! I have a cultural explanation
on why “Indians” die fifteen years earlier when they migrate to the west. Acculturation leads to unhealthy behaviour.
A plethora of new drugs to combat Type 2 DM
were paraded by professorial peons from the academia. None of the newer drugs
can quantitatively improve Type 2 DM control at a level comparable to Lifestyle
modifications: whether it is prevention or treatment. The apologists for the
newer drugs that improve Diabetes control by a mere 0.7 % begin their drama:
When the Lifestyle is no longer feasible…as if Lifestyle is just another pill
which has lost its efficacy.
Why are Metabolic Diseases such Obesity and
Type 2 DM are (a) so poorly treated and (b) so poorly controlled?
(a)
Responsibility of the doctor
(b)
Responsibility of the patient
There seems to be a discordance between (a)
and (b)
It seems that what the doctors are capable
of doing does not chime very well with what the patients of capable of…A
Medical Anthropologist would call it, a Conflict of Explanatory Models.
The fact that there exists programmes (such
as MoPoTsyo.org in Cambodia) peer educators who themselves were patients once
upon a time, advise and educate the patients in a non-clinical setting. And the
fact that the control of Diabetes at MoPotsyo.org is higher than what one can
find at the offices of a Family Practitioner or Endocrinologist in the USA or
in the Diabetes Clinics at Universities in the USA.
With MINIMAL medications (Metformin,
Insulin and Sulfonylureas) and MAXIMAL counselling and comforting, better
control has been achieved in one of the poorest countries on earth (Cambodia)
than the richest country in the world. It is accomplished at a cost that is
only a minute fraction spent on this disease in the western countries. When the
sugar does not come down, the first consideration is counselling about
Lifestyle since it is what contributes most to the control in this programme,
among other social forces.
The cost of Health care is driven up by the
Disease Care providers (the doctors) than by the DISEASE.
I will give you an example.
My sister who has survived one breast and
two lung cancers went to see a Dermatologist about a small patch of alopecia
areata (bald spot in the hair), came back with orders for the following blood
tests, which included:
FH.LSH, PROLACTIN, DHEA, ESTRADIOL,
TESTOSTERONE, T4, T3, TSH, UPTAKE along with normal tests (CBC, Metabolic Panel
etc.)
My sister and I along with her Family
Practitioner is concerned that the Dermatologist may have received a hefty
proportion of these tests thus ordered, the total costs may be between
1000-2000 dollars! Irrelevant tests to the problem of Alopecia Areata! Who is
driving up the costs of care for Alopecia Areata? The disease or the
dermatologist?
Let us talk about the patient. Why are they
reluctant to listen to the patient? Various studies in many countries have
revealed a similar pattern.
-Perceived prejudice of the doctor against
your culture (no wonder Vietnamese patients choose to go to Vietnamese doctors)
-Lack of trust in the knowledge of the
doctor. Medical advertisements and the media play up drugs and weight loss
programme and increase the expectations of the patients. The approval of a new
anti obesity drug, Lorcarserin, was covered by all major news channels as well
as all the on line news agencies! Lorcarserin can make you loose 3% of your
body weight, so if you weight 180 pounds, you can expect to loose at the end of
one year of swallowing the pill at a very high cost, about 5 pounds. Lifestyle
changes are much cheaper and healthier to boot. Internet, Media has increased
the chasm of lack of trust in the provider.
-Inability to pay for the unnecessary or
irrelevant drugs even when you have insurance
Lantus is the trademark of Glargine
Insulin, long acting insulin; it can be bought in the form of a pen with
prefilled syringes that may last a patient 10 to 15 days. Cost is over 600
dollars and even if you are billed 20 per cent by the insurance companies, you
may have to pay nearly 100 dollars. For people with limited incomes, 200 or so
dollars per month for medications is certainly burdensome… here in the richest
country on earth!
Instead of reaching out for the prescription
pad (supplied to you by the drug companies in many cases) Doctors could spend (and
learn to) on advice to change the lifestyle of the patients. (An overweight or
obese doctor is very seldom effective; it goes without saying, in persuading
the patient to change his or her lifestyle)
It is cheaper for the doctor to reach out
for the prescription pad and write the newer medication, justifying that
lifestyle and other medications have all failed. But the failure may not be due
to medications. However effective a medication may be, as one Surgeon General
had reminded us, it is only good if it is taken!
(Capitalism American Style, an ad in Financial Times for Investment company)
Responsibility for health is a shared
concern. Patients occupy a different space-financially, culturally –than the
providers. Patients need a little help with COACHING to improve their HEALTH,
they need an advocate. They turn to their doctors looking in them for a Coach
and Advocate but they are deeply disappointed.
As my colleague among the Indians has
repeatedly said: It is with the heart that one looks after a patient with
Diabetes and not with the mind.
HAVE A LITTLE HEART..
