American Diabetes Month: Diabetes Prevention and Management with Dr. Herman Johannesmeyer and Dr. Joyce Lee
November is American Diabetes Month, with World Diabetes Day observed on November 14. Dr. Herman Johannesmeyer and Dr. Joyce Lee are professors in the UC Irvine School of Pharmacy & Pharmaceutical Sciences who have dedicated themselves to researching diabetes and caring for people who are living with this condition or are at risk of developing diabetes. They’ve shared their expert insights on diabetes risk factors, prevention, complications, and treatment.
What are some risk factors for diabetes and signs of prediabetes?
“One of the difficult aspects of managing diabetes is finding out if somebody has it in the first place. Early in the course of the condition, there are relatively few easy-to-recognize signs that can reliably tell you if someone has diabetes or not,” said Dr. Johannesmeyer. “The best way to determine if you have diabetes or prediabetes is by getting bloodwork done that can tell your physician or pharmacist if your blood sugar is high. This underscores the importance of seeing your healthcare provider regularly even if you are healthy and feeling well, especially if you have risk factors for diabetes. It’s a lot easier to keep a healthy person healthy than it is to fix some of the complicated medical problems that can occur with late-stage diabetes.”
He added, “There are a few factors that can increase someone’s risk for developing diabetes. The American Diabetes Association (ADA) has a very helpful risk assessment tool. A few points within this tool that are associated with an increased risk of diabetes include older age, male sex, obesity, and physical activity. Another risk factor not captured by the ADA risk tool is specific dietary patterns, including eating foods that are referred to as ‘high glycemic index’ foods. These types of foods and drinks cause the blood sugar to rise to very high levels over a short period of time and are the most likely culprits in predisposing to diabetes. High glycemic index foods include sweet treats like candies or sweetened beverages and simple grains like white bread and potatoes.”
What can be done to reverse prediabetes?
Dr. Johannesmeyer shared, “If somebody has a slightly high blood sugar that doesn’t quite meet the definition of diabetes, sometimes we say a patient has ‘prediabetes.’ The name of the game in a patient with prediabetes is the control of diabetes-related risk factors. If somebody is overweight, weight loss can work wonders in helping to reverse blood sugar abnormalities. If somebody is physically inactive, regular exercise can help the body use up all the extra sugar in their blood in a healthy way. Most experts recommend 150 minutes of moderate-to-vigorous exercise per week to reduce the risk of diabetes. Another low-risk way to reverse prediabetes is by reducing the intake of high glycemic index foods, specifically sweetened beverages. This can include more than just colas and sodas!”
“In addition to lifestyle changes like diet and exercise, there are more medically complicated strategies to reverse diabetes,” he continued. “In some patients with pre-diabetes, starting the medication metformin as a preventative measure can help halt the progression to diabetes. In individuals with obesity, there is growing evidence that weight loss medications and weight loss surgery can have profoundly positive impacts on blood sugar. An individual’s best prediabetes reversal plan will ultimately depend on their specific factors, values, and priorities and is best developed collaboratively between the patient and their healthcare provider.”
What are some lifestyle changes that everyone can make to prevent the development of diabetes?
Dr. Lee said, “The American Diabetes Association provides evidence-based recommendations for lifestyle behavior change for diabetes prevention, and these include weight reduction of at least 7% of initial body weight through a healthy, reduced-calorie diet and a minimum of 150 minutes of moderate-intensity physical activities. When I convey this idea, I use the acronym S.W.E.E.T. — S stands for self-worth, W stands for weight reduction, the two Es stand for exercise and eat right, and T stands for timely. In order to eat well, exercise, and lose weight, people at risk must know their self-worth first — that they deserve to be healthy and that they can do so without delay. People with prediabetes are fortunate to still have the option to say no to diabetes, and healthcare professionals, including pharmacists, are great advocates for them.”
What are the most common health problems that arise from diabetes?
Dr. Johannesmeyer outlined some of the most widely seen diabetes complications: “There are a number of adverse health consequences that can come about from diabetes. In the healthcare world, we generally divide these into risks relating to the cardiovascular system and risks related to other organ systems. The cardiovascular consequences of diabetes are increased risk for heart attack and stroke and are one of the primary causes of death in patients with diabetes. Some experts consider diabetes to be a ‘cardiovascular disease equivalent,’ meaning that a patient with diabetes has as similarly a high risk for heart attacks and strokes as somebody who has had a heart attack or stroke before. The non-cardiovascular consequences of diabetes include decreased visual acuity potentially leading to blindness, kidney damage, and nerve damage manifesting as either decreased sensation in the feet or as an electric-like tingling sensation in the feet and legs.
There are a few risks associated with diabetes that we tend to see more frequently in hospitalized patients where I practice now. The high blood sugar associated with diabetes can have something of an immunosuppressant effect, leading to delayed recovery from things like pneumonia or stomach infections. In hospitalized patients, we tend to use complicated insulin regimens to control blood sugar levels to the best of our ability, but recent studies have shown that hospitalized patients with diabetes still tend to experience longer hospitalizations than patients who don’t have diabetes. Additionally, the development of decreased sensation and feeling in the feet associated with diabetes can cause an increased risk for foot infections. It’s possible for somebody with diabetes to experience a scrape, scratch, or puncture wound on their foot and not realize it. As such, it’s recommended that people with diabetes examine their feet daily to look for new injuries or ulcerations. If a new injury is seen, it should be promptly reported to your healthcare provider.”
What can people with diabetes do to improve their health and manage their condition?
“S.W.E.E.T. is still important, but making the acronym plural by adding an S at the end (S.W.E.E.T.S.) makes it holistic for people with diabetes. The added S stands for self-monitoring of blood glucose,” noted Dr. Lee. “Self-monitoring not only guides therapy directions, but it also empowers patients with a sense of control and responsibility to be a proactive participant in their own health. New developments in diabetes technology have been shown to improve quality of life for people with diabetes. Pharmacists can assist with this process, including applying for prior authorization, if necessary, and coaching patients on the use of these devices.”
How can pharmacists help with preventing diabetes health problems?
As stated by Dr. Lee, pharmacists are an essential — and convenient — resource for people who are working to prevent or manage diabetes and related health issues: “Pharmacists, especially community pharmacists, are accessible health ambassadors who can provide people at risk with the necessary health support. As the most accessible health professionals with a minimum of four years of postgraduate Doctor of Pharmacy (PharmD) training, pharmacists provide the public with advice on health and wellness, minor ailments, and medication and enhance communication between patients and their care team. Pharmacists are well-positioned to assist healthcare teams in delivering value-based care by providing close monitoring and regular check-ups to reverse prediabetes or delay the progression to type 2 diabetes.”