Diabetes

A physician's personal fight to prevent diabetes: Spreading the word

As a patient enrollee in her local diabetes prevention program, Nancy Nielsen, MD, PhD, didn’t want anyone to know she was a physician. But now she’s sharing her experience far and wide because it quite possibly changed her life.

Altering her family history

“My father had his first heart attack when I was in ninth grade, and he died at 62—a diabetic,” Dr. Nielsen, an internal medicine physician, told physicians last month. “So were both his parents and seven of his eight siblings. And so I knew: With a sedentary lifestyle, I was a prime candidate.”

Dr. Nielsen last month spoke to two groups of physician leaders at the 2016 AMA Annual Meeting and a special meeting of the AMA Accelerating Change in Medical Education Consortium and Improving Health Outcomes initiative, which focused on preparing students how to best care for patients with chronic diseases. Dr. Nielsen is a past president of the AMA and senior associate dean for health policy at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, The State University of New York.

“It was at an AMA meeting that I got my hemoglobin A1c,” Dr. Nielsen said. “It was creeping up. Isn’t denial so interesting in all of us? I thought I was eating healthy, but I never had time to measure or count or really worry about all this stuff. I really thought I was eating healthy.”

That’s when Dr. Nielsen got a referral from her primary care physician to participate in the YMCA’s Diabetes Prevention Program, which had become available for the first time at her neighborhood Y.

Dr. Nielsen isn’t in an uncommon situation when it comes to type 2 diabetes risk. In fact, 86 million U.S. adults—one in three—have prediabetes, according to estimates by the Centers for Disease Control and Prevention (CDC). What is far less common is that Dr. Nielsen knows her risk and is taking action to reduce it. The CDC estimates that only 90 percent of adults with prediabetes are even aware they have it.

Why the prevention program works

The YMCA’s Diabetes Prevention Program is based on the National Diabetes Prevention Program, which is offered by a variety of community organizations and even is available from some providers online. It’s an evidence-based program that helps patients with elevated blood sugar levels make the necessary lifestyle changes to prevent the onset of type 2 diabetes, one of the most disabling and expensive chronic diseases.

In the YMCA’s yearlong program, participants meet once a week for 16 weeks and then once a month for the remainder of the year. Participants meet as a group with an experienced life coach and learn the knowledge and skills to adopt healthy behaviors that lower their risk of developing type 2 diabetes. Two of the primary goals for participants are 5-7 percent weight loss during the course of the year and 150 minutes of weekly exercise, changes that can cut a patient’s diabetes risk by more than half.

“If you looked at the curriculum, you as physicians would be bored,” Dr. Nielsen said. “It’s very simple.”

“[But] that is not the power,” she said. “The power is being together, having a life coach. The dynamics of changing human behavior are not just knowledge.”

Dr. Nielsen admitted that she isn’t one who enjoys working on her individual goals as part of a group, but being part of a group and working together toward common goals was very motivating.

“One night just for fun, [our group’s life coach] brought in a bunch of foods and put them on the table, and we had to guess” how many calories and grams of fat were in them, Dr. Nielsen said. “And, boy, were we off. And I wasn’t better than anyone else.”

Dr. Nielsen explained that the program included such practical activities as counting fat grams and recording everything they ate. There were weekly weigh-ins, and the Y provided access to its facilities and a session with a fitness trainer.

Out of the 35 people in her group, every single one of them met their 7 percent weight loss goal.

What physicians can do

Dr. Nielsen encourages all physicians to refer their patients with prediabetes to a diabetes prevention program.

“In our curriculum, how do we teach nutrition?” Dr. Nielsen said. “When I took it, it was biochemistry … [and offered] very little practical advice. As a busy internist, I didn’t have time to sit and talk about nutrition with people. And frankly from a practical standpoint, I wouldn’t have known what to tell people.”

Referring patients to a diabetes prevention program gives patients access to the information and support that they need to make important lifestyle changes without placing the resource burden entirely on busy physician practices.

In partnership with the CDC, the AMA offers the Prevent Diabetes STAT: Screen, Test, Act–Today™ toolkit, which makes it simple for physicians and their care teams to screen, test and refer patients to diabetes prevention programs.

Participation in the programs is covered by some insurers, which soon will include Medicare.

“[The program] was only $320, which is only $20 per night,” Dr. Nielsen said. “But for many patients, that would be a barrier. We as physicians need to advocate for insurers to cover it. I really think that’s part of our role.”

For educators who are training the next generation of physicians, Dr. Nielsen said this program offers important lessons in chronic disease care and prevention. “Students need to understand that they don’t have to know everything,” she said. “What they do need to do is partner with the resources in their community like the AMA and the CDC have done with the Y. This has been around for a while, is evidence-based, and the results are stunning.”

Dr. Nielsen left physicians with an important thought: “I think it’s time that we learn from other disciplines outside of medicine to help our patients become as healthy as they possibly can. This may allow me and others to outlive our family history.”