San Antonio: A City at War Against Diabetes

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Health advocates gather for a meeting of the San Antonio Diabetes Collaborative (from left) Metro Health Director Dr. Thomas Schlenker, Dr. Robert Ferrer of UT Health Sciences Center, Councilmember Ron Nirenberg (D8), Charles Knight of Bexar County Health Collaborative, and Jennifer Herriott, Senior Health Director at Health Resources in Action. Photo by Mitch Hagney.

Health advocates gather for a meeting of the San Antonio Diabetes Collaborative (from left) Metro Health Director Dr. Thomas Schlenker, Dr. Robert Ferrer of UT Health Sciences Center, Councilmember Ron Nirenberg (D8), Charles Knight of Bexar County Health Collaborative, and Jennifer Herriott, Senior Health Director at Health Resources in Action. Photo by Mitch Hagney.

“When it comes to diabetes, San Antonio is winning battles everyday, but we’re losing the war.” said Dr. Thomas Schlenker, director of Metropolitan Health District in San Antonio.

Dr. Schlenker addressed his health care allies with gravity at the latest meeting of the new San Antonio Diabetes Collaborative on Tuesday.

According to Metro Health, 18% of Bexar county’s population is diabetic. The national average is 7%. In addition, 35% of Bexar county residents are classified as “pre-diabetic,” when a person’s blood sugar is high, but not technically high enough be classified as Type 2 diabetes.

A diabetic, half-foot amputation which usually follows initial toe amputations by 12-24 months. Image courtesy of Metro Health.

A diabetic, half-foot amputation which usually follows initial toe amputations by 12-24 months. Image courtesy of Metro Health.

“The Diabetic amputation rate (in Bexar County) is three times the national average. We know why we’re here, to figure out the best way to combat this disease,” he said.

Health professionals from around the city and Councilmember Ron Nirenberg (D8) nodded their heads in agreement.

The Diabetes Collaborative represents a significant shift in the city’s diabetes treatment program because of the strategy and number of organizations involved – more than a dozen public and private health agencies are represented, including the San Antonio Food BankBaptist Health System, Humana, UT Health Science Center, the YMCA of Greater San Antonio.

“At our last meeting, we decided that our primary goal is to delay or prevent pre-diabetics from advancing to full diabetes. That is the decision of the group, and while that’s not the only potential place of improvement, that is where we think we can get the biggest bang for our buck,”Dr. Schlenker said.

To accomplish that, the group split it into three smaller goals: make pre-diabetic treatment better, gather more data on the total pre-diabetic population, and improve education programs and environmental conditions to prevent the disease.

None of the goals will be easy to attain.

Diabetes, like other chronic diseases, is caused by a combination of genetic and behavioral factors. Historically, doctors are good at treating those diseases, but bad at preventing them. Pre-diabetics have elevated blood sugar, but not as high as full diabetics. Behaviorally, diabetes is caused by bad eating habits, and to a lesser degree, coupled with a lack of physical exercise.

Most of the Diabetes Collaborative’s Tuesday meeting was spent determining the wording and general tactics the group will take while moving forward. Towards the end, many organizations proposed new strategies they would undertake independently as part of the coordinated group effort.

From left: San Antonio Food Bank Director of Nutrition Dr. Luz-Myriam Neira, Denise Daniels of CommuniCare Health Center, Metro Health Director Dr. Thomas Schlenker, Dr. Robert Ferrer of UT Health Science Center, and Councilmember Ron Nirenberg (D8) strategize during the San Antonio Diabetes Collaborative meeting. Photo by Mitch Hagney.

From left: San Antonio Food Bank Director of Nutrition Dr. Luz-Myriam Neira, Denise Daniels of CommuniCare Health Center, Metro Health Director Dr. Thomas Schlenker, Dr. Robert Ferrer of UT Health Science Center, and Councilmember Ron Nirenberg (D8) strategize during the San Antonio Diabetes Collaborative meeting. Photo by Mitch Hagney.

New screening tools will be implemented at locations like the YMCA’s work site programs and Methodist Healthcare Ministries’ community engagement programs to increase the registry of pre-diabetics. A pre-diabetes screening tool will be adopted that can be shared by all partners, which currently are split between ADA and CDC standards that are frustratingly different.

Screening at doctor’s offices also will expand to include mental health analysis after comments from Judit Vega, Metro Health’s Neighborhood Health Coordinator, demonstrated a clear correlation between depression, anxiety, and adverse childhood experiences with diabetes.

Humana and its partners will release a local diabetes resource guide that provides information and screening, treatment, and healthy lifestyle options in San Antonio. Locations on where residents can be tested will be available in the resource guide. The Food Policy Council is creating a list of recommended and discouraged foods for health events around the city, working to remove things like funnel cake from Síclovía’s programming. Other groups plan to record and categorize all of the city’s hospital and community organizations’ diabetes prevention programs to bring them in line with coordinated efforts.

Others promised to explore collective funding options for an independent health trust to fund prevention efforts. Funding schemes on that program are still in development.

Councilmember Nirenberg reported that every technical work group for SA Tomorrow would have a representative from Metro Health, including the work group for the Built Environment that will address exercise, gardening, and walkability through infrastructure.

“Health professionals have clearly indicated that diabetes is one of the most important health concerns of our time,” Nirenberg said. “Not addressing it translates to real dollars and cents to those who live in San Antonio, not to mention the quality of life of those afflicted and their families. For me, this collaborative effort is about bridging the gaps between the many organizations doing incredible work on this. I’m here because policymakers have a big role to play in this process right alongside medical professionals.”

The next large Diabetes Collaborative meeting will happen in September. Action items will be reviewed and responsibilities moving forward will be allocated.

An outline of the San Antonio Diabetes Collaborative's goals and strategies. Photo by Mitch Hagney.

An outline of the San Antonio Diabetes Collaborative’s goals and strategies. Photo by Mitch Hagney.

The Diabetes Collaborative’s participants stopped short of sounding optimistic.

“We need patients to be involved the process here so that we can craft strategies that are responsive to them,” one practitioner said. Later, another responded testily to a comment about enhanced screening at doctor’s offices that, “It won’t work unless we have community buy-in. We need organizers on the ground.”

Members of the collaborative include representatives from Metro Health, Healthcare Access San Antonio, the San Antonio Food Bank, Baptist Health System, Humana, UT Health Science Center, the South Alamo Medical Group, Bexar County Community Health Collective, Methodist Healthcare Ministries, Allegian Health Plans, CommuniCare Health Centers, Texas Health and Human Services Commission, the Public Health Foundation, the Food Policy Council of San Antonio, the YMCA, and members of City Council.

For those interested in joining the group, email Dr. Schlenker at Thomas.Schlenker@sanantonio.gov.

For information about diabetes and treatment, visit Diabetes.org. To get screened for diabetes, visit the Texas Diabetes Institute.

 

*Featured/top image: Health advocates gather for a meeting of the San Antonio Diabetes Collaborative (from left) Metro Health Director Dr. Thomas Schlenker, Dr. Robert Ferrer of UT Health Sciences Center, Councilmember Ron Nirenberg (D8), Charles Knight of Bexar County Health Collaborative, and Jennifer Herriott, Senior Health Director at Health Resources in Action. Photo by Mitch Hagney.

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5 thoughts on “San Antonio: A City at War Against Diabetes

  1. This article notes that physical activity is a factor in diabetes. The CDC and many other health organizations have found strong correlation between diabetes, auto-dependence, and urban sprawl. Here’s a long list of CDC sponsored research: http://www.cdc.gov/healthyplaces/articles.htm

    City and county government own and can solve the sprawl problem. That alone may not solve the obesity and diabetes epidemics, but research suggests neither of those epidemics will be solved if the built environment is not fixed. There are host of other benefits associated with mitigating sprawl, and it seems there is plenty of recognition that a compact and connected San Antonio is desired. So, let’s just go after this problem by tearing down the policies that create sprawl and replace them with policies that create compact and connected places.

  2. There is an interesting study that links weight loss surgeries (gastric bypass, eg) with a remission of diabetes. I remember seeing it on 60 Minutes. Since Americans are bearing the financial burden of expensive diabetes treatments for senior and low-income folks, I personally would much rather pay the up front costs of weight loss surgery for the chance at avoiding the long term costs. See below link–it’s just fascinating!

    http://www.cbsnews.com/news/new-study-weight-loss-surgery-may-cure-diabetes/

  3. Great article of Mitch Hagney in The Rivard’s Report, the headline is true and the Army must be every one of us, like all this guys on the pictures working together with responsibility and professionalism to resolve one of the priority community needs. Excellent leadership of Dr. Schlenker and very effective support of Councilman of District 8, Ron Nirenberg he understand very well the serious impact of the Diabetes in the health and economy of individuals and his families.

  4. Pre-diabetes is curable with diet and exercise. However, the carb cravings that accompany blood sugar issues can make it difficult to make necessary dietary changes. Gymnema, an ancient Ayurvedic herb, is very helpful for curbing these cravings as well as for helping regulate blood sugar. Acupuncture can also help with various aspects of diabetes and pre-diabetes.

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