Specialized Diabetes Centers Focus on Prevention
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Type 2 diabetes is preventable, but its incidence is increasing nationwide — fueled in large part by the fact that a large percentage of the population is either overweight or obese. As the number of cases rise, physicians in specialized centers are focusing on preventing complications from the disease.
“Almost every family is affected by the challenges of obesity and diabetes,” says Anthony Heaney, M.D., Ph.D., clinical chief of the UCLA Division of Endocrinology. “At UCLA, we believe a multidisciplinary team of experts — diabetologist, diabetes educator and dietitian — is the best way to help diabetes patients take back their health.”
This team-based approach, along with the individualization of therapy to the patient’s social and economic circumstances, is what distinguishes the UCLA Diabetes Program, says diabetologist Jennifer Han, M.D. “The future of diabetes care is to target people with earlier-stage diabetes as well as those with pre-diabetes so that we can prevent complications from occurring.”
Although a number of medications are important to the treatment of diabetes, lifestyle factors — including healthy nutrition, physical activity and self-monitoring — are vital strategies.“It all boils down to patients wanting to change their health,” Dr. Han says.“With our team-based approach, there is accountability, consistency and people there to make sure patients are doing the best they can.”
Many patients assume that medication alone will keep their blood-sugar levels in check. “Diet and physical activity work synergistically with medication to control diabetes,” says Shiri Morgan, M.P.H., R.D., C.D.E., a dietitian and certified diabetes educator in the program. “You need to do everything.” Dietary strategies depend on the patient, but typically include reducing carbohydrate portions to prevent peaks in blood sugars. “A diabetic diet is, in reality, a heart-healthy diet,” Morgan says. “You can eat normal foods; you just have to watch how those foods affect blood sugar and make adjustments.”
The introduction in recent years of new technology to assist with diabetes management at home — including insulin pumps and continuous glucose monitors — provides patients with more information and greater flexibility, but also more responsibility for their care, notes Evelyne Fleury-Milfort, N.P., a nationally recognized diabetes educator and nurse practitioner supervisor at the UCLA Diabetes Program. “This increases the importance of education, because if patients do not have a good understanding of how to use the new technology, it can potentially be harmful,” Fleury-Milfort says.
While type 2 diabetes is preventable, there are certain factors such as family history or borderline levels of blood sugars that might put a person at higher risk for the disease. An evaluation from a center like UCLA’s might help patients to determine their level of risk.
More so than in many chronic diseases, decisions made by individuals who have developed diabetes go a long way toward determining their health. “Our role is to help patients become active participants in their care by giving them the knowledge and skills to make informed choices,” Fleury-Milfort explains. “The better we can educate patients and support them through one-on-one as well as group classes, and increase their participation in their care, the more likely they are to lessen the incidence of complications and enjoy a good quality of life.”