Top Diabetes Doc: Science and Medicine are Tools for Justice

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University of Texas Health Science Center at San Antonio. Courtesy photo.

University of Texas Health Science Center at San Antonio. Courtesy photo.

“People overestimate their height, women underestimate their weight – and everybody overestimates how much they exercise,” quipped Dr. Griffin P. Rodgers as he presented the annual Frank Bryant Jr. M.D. Memorial Lecture in Medical Ethics, held Tuesday night at University of Texas Health Science Center at San Antonio. Rodgers’ joke was one of the only moments of levity in a presentation otherwise devoted to a particularly deadly disease here in South Texas: diabetes and its connection to obesity.

Dr. Griffin P. Rodgers

Dr. Griffin P. Rodgers

Rodgers was in town to deliver his talk on “Science: A Tool for Justice,” from the National Institutes of Health (NIH) in Washington, D.C. where he heads the National Institute of Diabetes and Digestive and Kidney Diseases. The title of his talk was a way of drawing attention to how the burden of disease “can fall unequally upon people of color,” Rodgers said. While a lecture on diabetes and obesity might seem like a unique way to celebrate Black History Month, it’s less so when you look at “science and medicine as tools for justice” in the case of health disparities among communities as Dr. Rodgers does.

Click here to watch his presentation via NOWCastSA.

Diabetes, for example, is an increasingly common disease of metabolism that affects the body’s ability to produce insulin and regulate blood glucose levels. While Type II diabetes, the non-inheritable kind, is on the rise nationally, it’s also true that it affects people of color in greater proportions, including African Americans, Hispanics, Native Americans and Pacific Islanders. All told, diabetes affects almost 10% of Texans; with another 12% estimated as undiagnosed.

Blacks and Hispanics are both 1.5 times more likely to be diagnosed with the disease, and 1.5 times to twice as likely to die from it, respectively. Blacks are three times as likely as whites to end up on dialysis, a consequence of end-stage kidney disease, to which diabetes is linked. Surprisingly, although African Americans represent only 13% of the population, they make up 1/3 of those who are on dialysis or are waiting for a kidney transplant, Rodgers said.

Here in the Hispanic-majority of San Antonio, figures for diabetes are “double the national average,” according to the local chapter of the American Diabetes Association. All told, diabetes is the sixth leading cause of death in Texas, and the fourth leading cause of death in Bexar County, according to statistics compiled by the Texas Diabetes Institute, which Dr. Rodgers visited on Wednesday.

Nationally, diabetes is on the rise. The prevalence of adults 18 and older with diagnosed diabetes increased 157% from 1980 through 2011, according to the Centers for Disease Control and Prevention (CDC), in a manner not reflecting changes in the age structure of the population. In fact, by the year 2050, 50 million Americans are predicted to have diabetes, Rodgers said, calling the disease “chronic, common, consequential and costly.”

National healthcare costs are significant: Annual costs for Type II diabetes run to $245 billion; obesity, $147 billion; and chronic kidney disease, $29 billion, according to Rodgers.

The only truly good news is that there is some good news, at least for those who have not yet developed the disease. “We’re learning that prevention is better than treatment,” said Rodgers in an article published by the Robert Wood Johnson Foundation, where Rodgers had served as a fellow, and he expounded on that Tuesday night.  Modifying diet and exercise — as little as 30 minutes of walking, five times a week — “is effective in all age groups, and all ethnic and racial groups” for people who are at high risk for developing diabetes.

While experts initially doubted that lifestyle interventions could provide much benefit, “we proved the critics wrong,” said Rodgers. Such techniques have been written up in the New England Journal of Medicine. At UTHSCSA Tuesday, Rodgers described how the NIH has gone on to partner with the YWCA to help involve more community members in programs that can help to stave off the disease.

Obesity is often the beginning of the slippery slope of health problems, and more than a third of Hispanic adults in Texas self-report as being obese, according to statistics provided by the CDC. In fact, Texas is one of the six heaviest states in the country for Hispanics, according to the same material.

Excess sugar consumption has been implicated in obesity, which in turn can lead to diabetes and kidney disease, and a few communities nationally have taken steps to try to restrict consumer access to sugary drinks. San Antonio was one of them, but the initiative has stalled out, though it remains a priority of the Metropolitan Health Department, as described in previous articles in the Rivard Report.

Locally, Metro Health and the YMCA of Greater San Antonio have partnered to provide programs for those at risk for pre-diabetes. For more information, go to www.diabeteshelpsa.com.

Andrea Medina. Photo by Lily Casura.

Andrea Medina. Photo by Lily Casura.

During the Q&A session following the lecture, Andrea Medina, a “promotora” or community health worker affiliated with the Robert B. Green Clinic, part of the University Health System, asked Dr. Rodgers about the connection between diabetes and depression, particularly as it affects her patients whose mental health issues impede managing their diabetes.

“It’s very challenging,” she said. “We don’t have many resources (available) here to help them control their diabetes.”

“Studies show that depression and diabetes may be linked,” according to NIH literature, “but scientists do not yet know whether depression increases the risk of diabetes, or diabetes increases the risk of depression. Current research suggests that both cases are possible.” Something as simple as staying on an insulin regimen for diabetes can be complicated when mental health issues are involved, and Dr. Rodgers affirmed that more attention needs to be paid to the overlap between mental and physical health, with an increasing need to destigmatize mental health issues.

(From left) Dr. Ruth Berggren, director of the Center for Medical Humanities & Ethics at the UT Health Science Center; Dr. Griffin Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases; Gloria Bryant, wife of the late Dr. Frank Bryant Jr. for whom the lecture was named; and Dr. Adelita Cantu, assistant professor in the UT Health Science Center School of Nursing and president of the Community Leadership Board of the American Diabetes Association's San Antonio chapter. Photo by Lily Casura.

(From left) Dr. Ruth Berggren, director of the Center for Medical Humanities & Ethics at the UT Health Science Center; Dr. Griffin Rodgers, director of the National Institute of Diabetes and Digestive and Kidney Diseases; Gloria Bryant, wife of the late Dr. Frank Bryant Jr. for whom the lecture was named; and Dr. Adelita Cantu, assistant professor in the UT Health Science Center School of Nursing and president of the Community Leadership Board of theAmerican Diabetes Association's San Antonio chapter. Photo by Lily Casura.

The Frank Bryant Jr. M.D. Memorial Lecture in Medical Ethics is an annual event, put on by UTHSCSA’s Center for Medical Humanities and Ethics. It honors its physician and community leader namesake, the cofounder and first medical director of the Ella Austin Health Clinic and co-developer of the East San Antonio Medical Center. Dr. Bryant also served as the first African-American president of the Bexar County Medical Society.

*Featured/top image: University of Texas Health Science Center at San Antonio. Courtesy photo.

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One thought on “Top Diabetes Doc: Science and Medicine are Tools for Justice

  1. Lots of thoughts jump out from this article. First, San Antonio is not unique, but rather just early adopters. Second, it’s a national problem, not a regional problem, and therefore there must be a systemic cause. And last, there are likely multiple factors involved, including nutrition, and community neglect and bad public policy that discourages daily activity. The problem is complex, and therefore the solutions are likely complex.

    Looking at the maps, Texas, South Texas and San Antonio have higher rates of obesity and diabetes than national averages. It is worse in this region today than it was 20 years ago, but 20 years ago this region already had higher rates of diabetes and obesity. It’s not a new problem, it’s an old problem that has progressed. Moreover, it seems the whole nation is on track to reach the same high levels. Just give it time. No state is improving, every state is declining. We aren’t alone, we are just early adopters of obesity and diabetes. Therefore, you could conclude the problem is systemic.

    I see a correlation between this problem and the growth of vehicle miles traveled (VMT). VMT has almost tripled since 1970 (http://www.fhwa.dot.gov/policyinformation/travel_monitoring/historicvmt.pdf). This is not adjusted to population increase, but adjusting for population increase you would find that per capita VMT has increased dramatically as well. Many argue there is a correlation between driving, obesity, and all of the consequences of obesity. Without looking, I am confident that there are studies that find causal relationship between auto-dependence and the obesity and diabetes epidemics. However, I’d go a step further and assert that auto-dependence has more contributing factors than just the use of cars for almost every trip. Auto-dependence makes communities less … much, much less … appealing for daily exercise. The simplest and most effective exercise in preventing obesity and diabetes is not spin classes, gym membership, or crossfit, but the simple act of walking while getting things done. Public policy that mandates low-density, single-use development and excessive mobility (auto-dependence) have done a wonderful job of creating and sustaining a previously non-existing public health epidemic.

    Solutions? Stop subsidies to high fructose corn syrup and all related products. Taxes serve other purposes than simply raising revenue, and can be used to press public policy. That was the logic behind tobacco taxes, and is the logic behind alcohol taxes, so tax sugar, or corn, or high fructose corn syrup, then use that revenue to rebuild our communities and undo the damage from low-density, single-use development. To steal from the City of Austin comprehensive plan, make San Antonio, and cities across the nation “compact and connected”. Bring back walking just to get things done.

    This report suggests another issue exists. Obesity and diabetes are worse in low income communities. No doubt multiple factors contribute, but judging from the community around our home, I believe a major factor is the neglect and disinvestment in low income communities. These communities need the same care as other parts of the city. Nice sidewalks, without obstructions. Nice parks that are safe to walk to. The biggest safety concern is not crime, but traffic and the barriers imposed by wide roads and high speed traffic.

    Or, just keep doing what we are doing and watch the problem get worse. We’ll need new colors for obesity > 35% and diabetes > 10.%, and Texas will be among the first states to reach those new targets. We can’t call them anything other than targets if the public policy that created the problem is sustained, because continuing those same policies will move us towards new targets.

    Now, please excuse me while I get on my bike to get things done.

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