Health-June 15, 2015

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HEALTH • June 15, 2015 15 DIABETES AND OBESITY GO HAND-IN-HAND they have it, or reduce their risk if they're not yet diabetic. That's primarily accomplished through diet and exercise. Staying lean is a person's best defense against developing Type 2 diabetes; Type 1 is usually diagnosed in children and young adults, according to the American Diabetes Association (ADA), and these patients do not produce any insulin. Type 2 diabetes, on the other hand, is acquired, usually later in life, and is linked to inactivity and obesity, according to the ADA. Patients with Type 2 struggle with high blood glucose, and they produce insulin but are insulin resistant. People with poorly- controlled diabetes are at risk for serious complica- tions including stroke, heart attack, blindness, kidney failure and amputation. Cardiologist underscores diet over exercise as prevention key Dr. Marcus Cooper, a cardiologist at UMass Medical Center in Worcester who also researches methods to mitigate obesity at the University of Massachusetts Medical School (UMMS), said the development of diabetes boils down to calorie con- sumption, and dietary changes — not exercise — are paramount in preventing and controlling Type 2 diabetes. Exercise is important for maintaining weight, he said, but as far as losing weight, "it plays some role, but not as much as you'd probably think." Cooper said the wider availability of food through- out society, as well as larger portion sizes and the low cost of fast food, are to blame. Cooper cites data adapted from the U.S. Centers for Disease Control and Prevention (CDC) showing that between 1976 and 1980, about 52 percent of Americans had a normal body mass index (BMI) while the rest were either overweight or obese. By 2008, just 32 percent of Americans had a normal BMI; the rest were overweight or obese, at almost identical rates. Cooper also noted that CDC data mapping the incidence of diabetes and obesity in the U.S. is almost "superimposable," meaning that the rates of obesity and diabetes are regional, and strong- ly correlated, across the country. Those with Type 2 diabetes who need medication to help control blood sugar receive drugs that help curb glucose production, or sometimes receive insu- lin, but Cooper said the best thing for patients to do is to lose 5 to 10 percent of their body mass. In most cases, Cooper said, patients who do this are able to take fewer medications, or don't need them at all anymore to control their blood sugar. Meanwhile, the drug industry continues to pro- duce new treatments, but Cooper said the problem of Type 2 diabetes is becoming too large to simply throw medications at it. "Yes, we have more drugs to give to people, but there is no cure," Cooper said. There might not yet be a cure, but providers work diligently to help improve outcomes for the growing diabetic population. RN touts holistic approach Take the Wound Care Center at Saint Vincent Hospital in Worcester. It opened two years ago, offer- ing hyperbaric oxygen therapy for diabetics with serious wounds that require intensive treatment to avoid limb amputation. Before the center opened, Worcester-area patients had to travel to Boston, or to Harrington HealthCare's wound care center in Charlton, to receive hyberbaric therapy. Given the size of the city, there was a great local need for these services, said Debbie Bistoli, chief operat- ing officer at Saint Vincent. The center also offers services from a team of specialists, such as a podiatrist and a vascular surgeon, to provide patients with a "one-stop shopping" experience, according to Cheri Klinghard, a registered nurse who oversees the center. The center sees some of the sickest diabetes patients, and treating them holistically is necessary, said Klinghard. With an 85-percent healing rate, the center has alter- native therapies it can use if hyperbaric therapy is ineffective. Avoiding amputation is vital, according to Klinghard, because a patient who has undergone an amputation has a higher mortality rate than that of a breast cancer patient. This is because the patient becomes less active, and inactivity makes diabetes harder to control, Klinghard explained. "We have all this awareness around cancer, which is great," Klinghard said. "But foot ulcers can be just as deadly." But getting better also requires work by the patient. Those who are diligent about keeping appointments and — with the help of providers — managing their disease tend to fare the best, Klinghard said. She admitted it can be a challenge for some patients to make the right decisions. "We're just left trying to help them through those choices and lead them in the direction of a better life," Klinghard said. Diabetes: There's an app for that Meanwhile, a team of researchers at UMass Medical School (UMMS) is investigating how a smartphone app that tracks foot wounds as well as other diabetic vital signs may help patients control their disease. The app, called "Sugar," was developed by an engineering and technology team at Worcester Polytechnic Institute in collaboration with UMMS researchers. UMMS has just begun enrolling patients in a pilot study to see how effective the app is at helping diabet- ics manage their weight and blood sugar, while also allowing providers to track foot wounds and their healing status in order to prevent serious infections. The wound assessment technology sets the Sugar app apart, but there are many diabetes management apps available today, said Sherry Pagoto, associate professor of medicine and a licensed clinical psy- chologist at the UMass Memorial Weight Center. Pagoto, who shared her expertise in behavioral sci- ence pertaining to diet, exercise and diabetes man- agement during the Sugar app's development, said the key will be getting patients to stick with the app and not give it up after a few weeks. For that reason, the pilot study is using counselors who keep tabs on the users and their activity as a way to keep them engaged. DIABETES: 1994 2013 OBESITY: 1994 2013 Debbie Bistoli, chief operating officer, Saint Vincent Hospital Cheri Klinghard, R.N., program director of Saint Vincent's Wound Care Center Continued on Page 29

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