This story is the second installment in our three-part series on the nation’s diabetes epidemic.
NEW YORK – About one in five American adults visit an emergency room each year. They usually seek care for an urgent health problem. But these moments of contact with the health care system create opportunities to discover other underlying undiagnosed problems.
For example, at New York University hospitals, emergency room nurses are required to offer HIV testing to every patient who walks through their doors.
Dr. Reed Caldwell, service chief of NYU’s Langone Perelman Emergency Department, saw an opportunity to look for another insidious disease, one that often goes undiagnosed for far too long.
“In the communities that we serve, the threat of diabetes, prediabetes, is actually more than the threat of HIV today,” he says. “So I started thinking about ways we could incorporate diabetes screening into our patient care.”
Four years ago, one of NYU’s hospitals in Brooklyn began offering emergency room patients the A1C blood test. The test, which measures the level of sugar in the blood, is used to diagnose diabetes.
NYU Brooklyn ER offers diabetes testing to all patients
Caldwell is most concerned about patients who are at high risk for type 2 diabetes. “Patients over the age of 35, patients with a BMI greater than 25, and patients who have no history of diabetes or prediabetes, those are the patients we are flagged for. Let us examine them.”
Caldwell’s suspicions were confirmed: 40 to 50 percent of the patients tested tested positive for prediabetes or diabetes.
Before the pandemic, the number of people diagnosed with diabetes across the country had doubled in the last 20 years, and the coronavirus made matters worse. Experts don’t understand why, but new research shows that past COVID-19 infections are causing some people to develop diabetes. The need for early interventions, doctors say, is more urgent than ever.
“We need to keep working harder and we need to find people and we need to take good care of them,” says Dr. Caldwell.
Since then, NYU’s screening program has expanded to several of its emergency departments throughout the New York City area. When a patient tests positive for prediabetes or diabetes, they are linked to a provider who can help manage them.
“A big part of it has been that link to care and helping people find a primary care doctor or a health home,” Caldwell says.
But this kind of screening isn’t yet standard practice across the country, and it’s just the first step. Avoiding or reversing full-blown type 2 diabetes is no small feat; requires a complete lifestyle change.
“They need regular checks. They need a lot of education on the different pillars of lifestyle change,” says Dr. Michelle McMacken, executive director of nutrition and lifestyle medicine at NYC Health + Hospitals. “Let’s face it, it’s not easy in our society. People need to understand, how do I work with my family on this? What if I go to a party or go out to dinner? What happens when it’s too cold to exercise outside?
In 2019, at Bellevue Hospital, a government-run facility in New York City, McMacken helped launch a plant-based medicine program to better support patients with diabetes, prediabetes, and other chronic conditions.
“A suboptimal diet is actually the number one risk factor for dying from chronic disease. It dominates everything else. The evidence is very strong in terms of eating a plant-based or primarily plant-based diet to reduce risk,” she says.
Program patients are offered cooking classes and work with doctors, dietitians, health coaches and support groups to make lasting changes to their diets and daily habits.
“If it’s a relatively new diagnosis of type 2 diabetes and people make intensive lifestyle changes, we have great scientific data to show that many of them can go into remission,” he explains.
“This program, for me, has been like the wheel that keeps me moving forward, this team of people who are involved in this,” says Glenis Torres, a patient who went through the Bellevue program.
Torres was first diagnosed with prediabetes in her native Dominican Republic.
After moving to the US three years ago, she found out she was diabetic.
Before she enrolled in the Bellevue program, all of her previous efforts to change her habits were unsuccessful. Those efforts included a program based on payments for following a diet and exercise program.
Glenis Torres knew she needed to make lifestyle changes, but other programs hadn’t worked for her.
“You only received money. He didn’t give me any lessons like this program,” says Torres. “It only worked for me while I received the money and until I finished the program. But then I gained the weight back and my diabetes increased.”
During the pandemic, Torres’ health deteriorated further as the family spent a lot of time cooped up at home, watching TV and snacking.
Torres’ daughter, Yamile Santana, says: “We all put on weight. We weren’t going out.”
Torres became increasingly concerned about her health, particularly as she learned how pre-existing conditions like diabetes can lead to worse outcomes with COVID-19.
“A lot of people died. And diabetes puts people at higher risk. That shocked me, it shocked me a lot,” he says.
She also just wanted to feel better.
“I was living the life of an 80 or 90 year old. He was always tired. He never wanted to go out. He always wanted to sleep. So I said, I’m too young for that. I have a two-year-old grandson and I need energy,” explains Torres.
McMacken says that finding this kind of personal motivation is crucial to staying on track throughout the lifestyle medicine program.
“Usually we set out some kind of action plan to move forward. What is your why? What is your reason for being here? MacMacken says. “We identify what that why is really early on so that we can use it as an anchor as the patient goes through the program.”
Seven months after starting the program, Torres has seen a true transformation. He has lost almost 20 pounds, his blood sugar has dropped, and his mood has improved.
“Before, I was tired, depressed, sad, in a bad mood, and now I have energy to take care of my grandson, to do my thing,” she says.
Now, Torres is in the habit of making healthy plant-based meals for herself, swapping meat with tofu, white rice with brown, and adding plenty of vegetables. She has also changed her relationship with food.
Torres says the show has changed his entire relationship with food.
“Food is my ally,” Torres explains. “It’s what gives me energy, it’s what gives me health.”
Torres still enjoys some of the Dominican favorites, like rice and beans, but has learned to prepare them in healthier ways.
“I have added, for example, more yellow and red colors to my plate, which give me fiber and vitamins. I make brown rice with multicolored quinoa.”
Podcast
Erin Billups joined Spectrum News NY1’s Errol Louis podcast “You Decide with Errol Louis” to discuss their new collaborative special report “USA1C: Fighting the Rise of Diabetes,” currently airing on Spectrum News nationally.
Dr. McMacken says that a key component of the lifestyle medicine program is helping patients incorporate the foods they already eat into their new diets.
“I think it’s very important that we honor and celebrate cultural traditions,” she says. “Many healthy foods are often part of those cultural traditions and can be put in the center of the plate.”
Torres sees the need to expand education and access to healthier foods in her community.
“We Spanish-speakers, blacks, we think that eating healthy is not for us, because we come with the habit of eating differently, of eating fried foods,” he explains.
During a recent trip to a health food store, she had a daunting experience after asking a Spanish-speaking clerk for help finding ingredients.
“She said, ‘No honey, don’t look for that here. This supermarket is not for us, it is for white people. I felt sad.”
Black and brown communities experience the greatest burden of diabetes, partly because there are fewer healthier food options and partly because supportive lifestyle medicine programs like the one in Bellevue aren’t widely available. In these neighborhoods, diabetes can sometimes seem inevitable.
“There’s this tragic normalization where you hear people in conversation down the block or at church talking about, ‘oh, my sugar is acting up,’ like it’s a sprained ankle or something. You want to try to cut into the conversation and tell people that it doesn’t have to be this way,” says Spectrum News political anchor Errol Louis, co-reporter on this series.
When it comes to policy changes, Louis says, there is often a leadership vacuum.
“There’s no substitute for someone, whether it’s a governor or a mayor, a political leader of some sort, stepping up and saying this is what we’re going to do and that’s why we’re going to do it,” Louis explains. .
One notable transformation is very public in New York City: that of the current mayor of New York, Eric Adams. Six years ago, Adams was diagnosed with diabetes. He was losing sight in one of his eyes and experiencing tingling in his fingers and toes. Adams took matters into his own hands.
“He switched to a plant-based diet and within two months he was down, I think 35 pounds, within six months he had reversed the diagnosis,” Louis explains. “And ever since then he’s been an evangelist for a different lifestyle.”
Mayor Adams turned his diabetes around by switching to a mostly vegan diet
A longtime advocate for systemic change in healthcare, the Mayor is making Bellevue’s herbal medicine program available at six more sites, with Dr. Michelle McMacken leading the program.
“These evidence-based lifestyle behaviors can have a huge impact, not only in preventing and reducing the risk of chronic diseases, but also in treating these conditions and, in some cases, turning things around. Just like Mayor Adams did,” McMacken said at a press event announcing the program earlier this year.
“We have a mayor who was affected by diabetes, who took this particular course of action, who now believes he can scale it up and use it as public policy. You needed all three of those things to happen at the same time, since you have a budget that can accommodate it,” Louis explains.
Nationally, the CDC estimates that the annual cost of diagnosed diabetes is more than $300 billion. Added to this is the emotional cost for patients living with chronic illnesses and for those who care for them. Adams and McMacken hope the New York program can serve as a model for how public dollars can best be spent to fix the crisis.
“It’s not about how much this program costs,” Adams said at the press event. “[It’s] how much will it cost us if we don’t have this program. Our healthcare system is not sustainable.”
“We are pioneers here,” says McMacken. “What I would like to see is really this being a family concept, in the medical home and in people’s homes.”
For more information, see Part 1 and Part 3 of Erin Billups and Errol Louis’ joint series on the national diabetes crisis.
Source: news.google.com