a public health epidemic for America

DIABETES: A CATEGORY 5 HURRICANE FOR AMERICA

B Y E R I N F A I R C H I L D

Hmm, I’m in my mid-40s, have a family history of diabetes and I’m overweight. That’s really not so bad, Pearl Franklin thought to herself. After all, I’m smaller than everyone else in the family.

Sound familiar?

Franklin didn’t educate herself about her diabetes or ways to control it. She reminisced about how her diabetic father would sneak candy and other sweets when her mother wasn’t looking. And he was OK.

Sound familiar yet?

For years she ignored her diabetes until the day she found herself in her doctor’s office with chest pains. She was having a heart attack. Her refusal to come to grips with her medical condition had made her a statistic.

A person with diabetes has the same high risk of having a heart attack as someone who has already had an attack.”

Franklin, like thousands of other diabetics, was unaware that there is a close relationship between diabetes and heart disease. “I was in denial,” she said, now 10 years later. “That heart attack was a blessing. I realized right then and there that I wanted to be around a little longer.”

Diabetes researcher and endocrinologist Dr. Dale Hamilton says diabetes doesn’t get the attention that heart attack does because people don’t make the connection between the two although both can be deadly.

“A person with diabetes has the same high risk of having a heart attack as someone who has already had an attack,” Hamilton says. “And if someone with diabetes has a heart attack, he is four times more likely to develop heart failure.”

The heart muscle burns fat and glucose, or blood sugar, as fuel. A diabetic heart can’t receive glucose to burn and this can leave it starved for energy. So the diabetic heart burns a mixture rich in fat (triglycerides)from the blood. The body then reacts by increasing the amount of blood sugar, raising triglycerides and reducing the amount of good cholesterol (HDL) in the patient’s blood.

These compensatory changes accelerate the formation of plaque in the blood vessels, which hardens the arteries and increases the patient’s risk for heart attack and stroke. A vicious cycle is silently set in motion, a cycle of increased risk at a time when the heart muscle is weakened.

“It’s a tragic sequence, and it can go on for years,” Hamilton says. “The patient doesn’t feel acutely ill while this is going on, just sluggish, so it is easy to ignore. The patient may attribute it to aging and believe that nothing is wrong medically.”

But in fact, it’s like a storm brewing in the Gulf of Mexico, gaining force, eyeing the shore where it will bring torrential rain, raging winds and destruction. According to Hamilton, it’s a public health epidemic — a category 5 hurricane — for America.

Nearly 21 million Americans have diabetes. According to the American

METABOLIC SYNDROME RISK FACTORS

Risk Factor Defining level Body Mass Index > 30 kg/m2 Triglycerides >= 150 mg/dl HDL-cholesterol Men < 40 mg/dl Women <50 mg/dl Fasting glucose >= 110 mg/dl Blood pressure >=130/>=85 mmHg

Clinical identification of the metabolic syndrome is defined by presence of at least three of the five risk factors.

Diabetes Association, only 14.6 million have been diagnosed, leaving nearly one-third of diabetics unaware that they even have the disease.

The prevalence of diabetes grows exponentially as Americans accumulate characteristics of the metabolic syndrome — a group of conditions that increase your risk for heart disease and diabetes (see table).

Body fat located in the hip area, for example, is inactive. Body fat located in the central abdominal region of the body (between the rib cage and belly button) is the most dangerous kind of fat because it secretes toxic substances and chemicals (hormones) that contribute to heart and vascular disease. When a patient combines that with the increased risk from elevated diabetic blood sugar, the storm turns into a hurricane. By reducing abdominal fat, a patient can dramatically reduce his or her risk for heart attack and stroke. By controlling the diabetic blood sugar, the patient’s risk is even further reduced. Complacency in the early years of this process, however, can have an adverse effect on long-term survival and quality of life. Over the long-term (12 to 15 years), diabetes can reach an irreversible state, but before then it is reversible. DIABETES HEART PROGRAM Hamilton collaborated with the Methodist DeBakey Heart & Vascular Center to develop the Diabetes Heart Program, designed to help patients prevent the progression of diabetes and complications — heart attack and stroke — associated with it. Hamilton’sprogram, the largest in the country, is one of only two in the nation. His clinic sees approximately 3,000 patients a year.

Establishing a long-term relationship with each patient is essential to the success of the program, Hamilton says. “We must maintain a high-level continuity of care to be able to provide each individual with qualified, experienced people who have time to pick up the phone and answer the multitude of questions that arise when their patients are trying to control their blood sugar,” he said. “Managing diabetes is a daily struggle, and the program provides personal interaction and assistance whenever needed.”

The program provides medical nutrition therapy to help patients lose weight and maintain a healthy weight because diabetes often can be cured with weight loss.

Before joining the Heart Diabetes Program, Franklin had no energy. She was “tired and sluggish — just existing.” Now an active participant in the program, she has controlled her diabetes for a year. She says she knows more about how diabetes affects her body and how to treat it. “Now I am in control of my body and the disease,” she said. “It doesn’t control me.” For more information about the Diabetes Heart Program, call 713.441.4452. Dr. Hamilton and nurse practitioners (from left) J.R. Rollins, Eunice Ihaza, Paula Westergren and Saundra Hendricks discuss patient treatment plans.

Internationally recognized diabetes researchers join Methodist

Drs. Willa Hsueh and John D. Baxter, two of the nation’s foremost physician-scientists in the fields of diabetes and cardiovascular disease, have joined The Methodist Hospital Research Institute, expanding its ability to find better treatments and a potential cure for diabetes and its complications, such as heart attack and stroke. (See page 16 for more about these renowned physicians.)