The day I was born,
it was maybe one million people.
When I started my training,
it was three to four million people.
And now we have 37 million Americans
affected by diabetes,
90% of those, type two diabetes.
That is roughly one in ten in the United States population.
And the other side of this is that
there are probably about one in three
who have prediabetes,
and many actually don't even know that they have it.
The trends for obesity and diabetes
are happening globally.
Those two epidemics are starting
to outrank infectious diseases as far as global problems.
There are so many things at play here
that we have to address.
The body is tightly primed
to keep your blood glucose in a fairly narrow range.
When your blood glucose rises,
which usually happens after a meal, then you have insulin
that is secreted by cells in
your pancreas called beta cells.
The insulin then circulates in the body
and binds to receptors in the liver, in muscle,
in fat cells, and essentially will take the glucose back
into those organs,
and bring your glucose levels back into this normal range.
Now what happens in type two diabetes
is individuals become what we call insulin resistant.
And that is to say that insulin doesn't work
as well as it should.
In addition to that,
there's actually a defect in their beta cell
that limits the ability of the beta cells to keep producing
more and more insulin to overcome the insulin resistance.
What insulin does is allows the food that is in our body
to move from the bloodstream into our body's organs.
If you don't have insulin,
your bloodstream levels are high
of glucose or the food,
but your body can't use it.
“Take some deep breaths...”
Diabetes is a big risk factor
for a number of complications
if it's poorly controlled
like blindness, kidney disease, neuropathy, heart disease.
Diabetes tends to be associated with other
things like high blood pressure, high cholesterol.
And those three things put you
at increased risk for heart attacks and strokes.
It used to be that screening
happened at age 45
in all people, regardless of your background.
That is now true at age 35.
But if you have a family history or obesity,
you should screen at age 18 and above.
Most people will use a hemoglobin A1c test to screen:
5.6 and below is normoglycemia,
5.7–6.4 is prediabetes,
and 6.5 and above is a diabetes diagnosis.
There are people who certainly say, ‘oh, yeah,
you know, I have a touch of diabetes...’
The concept of prediabetes was coined
probably 15, 20 years ago.
Prediabetes, as it is, is not the disease, it's not a syndrome.
It's really a marker that you are at higher risk
of evolving into a diagnosis
of type two diabetes, if all things remain the same.
The question then is what can we do
to sort of reverse the clock?
I was a guy who was over 500 pounds.
I wasn't feeling real well.
Went over there and got checked.
They say, ‘you prediabetic, Tank...
You need to go see about yourself.’
Doctor checked me out, said
‘Hey man, you know, if you don't make these changes in your life,
you know, you won't see another graduation.
You won't see nothing.’
Right now I feel a lot healthier.
I’ve made the changes in my life.
I'm still working at it. But,
200 pounds later...
...this is me.
It's great that we catch people, you know,
you know, in the, in the middle of their crisis
and we can help them and get them the help that they need.
People with a prediabetes diagnosis,
if they prevent progression to diabetes,
will decrease cardiovascular complications, amputation,
and microvascular complications;
injury to the back of the eye,
the kidney, and the nerves.
If we look across the country
people of color are more commonly affected by diabetes,
and yet they are less commonly screened.
Screening for diabetes
is just one of the things that we can do
in community settings
to address pervasive and persistent disparities
in health outcomes.
We just want people to be, safe, you know, healthy,
you know, and just help people, you know,
that's all I'm trying to do.
The only way to stem this global epidemic,
it has to be prevention.
The most effective strategy
for preventing progression to diabetes
is lifestyle intervention.
It's not something that happens in the doctor's office.
In the United States,
the Diabetes Prevention Program is the only intervention
that can be covered by Medicare and Medicaid
outside of a medical setting.
I like to think of the Diabetes Prevention Program
as an extension of the primary care experience.
The National Diabetes Prevention Program
is what we call a lifestyle change program.
It is a full year of support for people
who are at risk for developing type two diabetes.
We focus on behaviors towards healthy eating
and behaviors towards being physically active.
And the research has shown
that if they can meet those two program goals,
they have an increased chance
of either
offsetting the onset of type two diabetes
or decreasing the risk altogether.
Things like working at the YMCA in a local community,
or getting screenings at a church or at a barber shop,
is a very exciting opportunity for us to try and gain trust,
and for us to show people
screening and treatment can improve their outcomes,
and that our agenda is the same as their agenda,
which is a long and healthy life.