Reversing Type 2 Diabetes: Power to the Patients

Q: How does economic disadvantage increase the risk for type 2 diabetes?

A: Economically disadvantaged people live in areas where controlling diabetes is a challenge. These areas typically lack stores that sell fresh produce; parks and other safe places to exercise are also in short supply. As a result, residents commonly are stuck with convenience stores and fast-food restaurants selling foods high in calories, fat and sugar. Poor diets and lack of exercise cause wei

When Dr. Joel Zonszein arrived at Einstein more than 20 years ago, most patients with type 2 diabetes — then called "adult-onset diabetes" — were elderly. Today, this disease is more common, more aggressive and more likely to affect the young. It is associated with obesity, insulin resistance, dyslipidemia and early heart disease and death.

This article originally appeared in the Summer/Fall issue of the Diabetes Research Center Newsletter."When diabetes is diagnosed and treated early, we can prevent complications, but that's not happening," says Dr. Zonszein, a professor of clinical medicine in the department of medicine (endocrinology) at Einstein. The incidence of the disease is skyrocketing, mainly among minorities, and it remains underdiagnosed and undertreated. One third of patients with type 2 diabetes don't know they have it; many of those who know they have it are not treated, and those who are treated are rarely treated optimally. "We should be doing a much better job," adds Dr. Zonszein, an attending physician in medicine at Montefiore, the University Hospital and academic medical center for Einstein.

Elevated Risk in the Bronx

Dr. Zonszein notes that change is especially difficult in underserved areas such as the Bronx, where the prevalence of diabetes among the borough's disadvantaged minorities is among the highest in the nation. Yet these patients have poor access to healthcare, struggle to afford medications and must hurdle language and cultural barriers. "It's frustrating, in this country, not being able to better prevent and treat such a common disease," he says.

Dr. Zonszein adds that inertia among patients — and among their doctors, too — prevents early and aggressive treatment. "We're working hard to improve healthcare delivery for this devastating disorder," he says.

Empowering Patients

Dr. Zonszein helps patients with type 2 diabetes help themselves. "It’s about healthier lifestyles for the entire family," he says."We've developed programs at Montefiore that give patients the power to manage their disease," Dr. Zonszein continues. In the Diabetes Self-Management Education Program, a registered nurse and a registered dietitian — both certified diabetes educators — teach type 2 patients to monitor their own weight, cholesterol, blood pressure and blood sugar; improve their diet; exercise more; and take their medicine.

Patients don't just "go on a diet" and sign on for exercise boot camp. "It's a matter of getting patients motivated," says Dr. Zonszein. "It's about healthier lifestyles for the entire family." Out with giant servings, sugary drinks, saturated fat and fried food; in with "slow food"—eating healthier, with less stress, and at a table, with family and friends.

Weight-loss goals in the program are realistic. As Sharon Movsas, R.D., C.D.E., the program coordinator, puts it, "The focus is on the plate and not the weight." The exercise plan involves setting equally reasonable goals: walking with a dog, going to a gym, starting an enjoyable sport. Most people leave the program healthier and happier.

These initiatives rest solidly on landmark trials emphasizing lifestyle change in which Dr. Zonszein has participated during his career. As a co-investigator in the Diabetes Prevention Program, a National Institutes of Health trial, he found that modest weight loss through diet and exercise was actually more effective than medication at reducing the risk for type 2 diabetes—confirming the power of the patient. Add early treatment to these already potent lifestyle changes and you really can help prevent the disease and its complications.