Teaching lifestyle changes could reduce diabetes

This story is the second in our three-part series on the nation’s diabetes epidemic.

NEW YORK – About one in five American adults visit an emergency room each year. They are usually seeking care for an urgent health problem. But these moments of contact with the healthcare system create opportunities to uncover other underlying, undiagnosed problems.

For example, at New York University Hospitals, emergency room nurses must offer HIV screening to every patient who walks through their doors.

Dr. Reed Caldwell, chief of service at NYU’s Langone Perelman Emergency Department, saw an opportunity to look for another insidious disease—one that often goes undiagnosed for far too long.

“In the communities we serve, the threat of diabetes, prediabetes, is actually more than the threat of HIV today,” he says. “So I started thinking about ways we could integrate diabetes screening into our patient care.”

Four years ago, one of NYU’s Brooklyn hospitals began offering the A1C blood test to emergency room patients. The test, which measures blood sugar, is used to diagnose diabetes.

NYU’s Brooklyn Emergency Room offers diabetes testing to all patients

Caldwell is most concerned with patients who are at high risk for type 2 diabetes. “Patients over the age of 35, patients with a BMI over 25, and patients without a history of diabetes or prediabetes, these are the patients that we must examine them.”

Caldwell’s suspicions were confirmed—40 to 50 percent of the patients examined tested positive for prediabetes or diabetes.

Before the pandemic, the number of people diagnosed with diabetes nationally had doubled in the last 20 years – and the coronavirus made it worse. Experts don’t understand why, but new research shows that past infections with COVID-19 cause some people to develop diabetes. The need for early interventions, doctors say, is more urgent than ever.

“We have to keep working hard and we have to find people and we have to take good care of them,” says Dr. Caldwell.

NYU’s screening program has since expanded to several emergency departments in the New York area. When a patient tests positive for pre-diabetes or diabetes, they are then connected to a provider who can help manage it.

“A lot of it was the linkage to care and helping people find a primary care physician or a health home,” Caldwell says.

But this type of screening isn’t yet standard practice across the country — and it’s just the first step. Avoiding or reversing type 2 diabetes is not a miracle; it requires a complete lifestyle change.

“They need regular check-ins. They need a lot of education around the different pillars of lifestyle change,” says Dr. Michelle McMacken, executive director of nutrition and lifestyle medicine at NYC Health + Hospitals. “Let’s face it, it doesn’t come easy in our society. People need to understand, how do I work with my family on this? What if I go to a party or dinner? What happens when it’s too cold to exercise outside?”

In 2019, at Bellevue Hospital, a government-run facility in New York City, McMacken helped launch an herbal medicine program to better support patients with diabetes, pre-diabetes and other chronic conditions.

“A suboptimal diet is actually the number one risk factor for death from chronic disease. It dominates everything else. The evidence is so strong about eating a plant-based or mostly plant-based diet to reduce risk,” she says.

Patients in the program are offered cooking classes and work with doctors, dietitians, health coaches and support groups to make lasting changes in their diet and daily habits.

“If it’s a relatively new diagnosis of type two diabetes and people make intensive lifestyle changes, we have great science to show that many of them can go into remission,” she explains.

“This program, for me, has been like the wheel that keeps me going, this team of people who are involved in this,” says Glenis Torres, a patient who went through the Bellevue program.

Torres was first diagnosed with pre-diabetes in her native Dominican Republic.

After moving to the US three years ago, she found out she was diabetic.

Before enrolling in Bellevue’s program, all of her previous efforts to change her habits had failed. These efforts included a program based on payments for following a diet and exercise program.

Glenis Torres knew she needed to make lifestyle changes, but other programs hadn’t worked for her

“You only got money. It didn’t teach me any lessons like this program,” says Torres. “It only worked for me until I got the money and finished the program. But after that, I put the weight back on and my diabetes went up.”

During the pandemic, Torres’ health declined further as the family spent a lot of time stuck at home, watching TV and snacking.

Torres’ daughter, Yamile Santana, says, “We’ve all gained weight. I wasn’t going out.”

Torres became increasingly concerned about her health, especially as she learned how pre-existing conditions like diabetes can lead to worse outcomes with COVID-19.

“Many people died. And diabetes puts people at greater risk. That affected me, it affected me a lot,” she says.

He also simply wanted to feel better.

“I was living the life of an 80- or 90-year-old. I was always tired. I never wanted to go out. I always wanted to sleep. So I said, I’m too young for that. I have a two-year-old grandson and I need energy,” explains Torres.

McMacken says finding this kind of personal motivation is crucial to staying on track throughout the lifestyle medicine program.

“Usually we establish some sort of plan of action to move forward. What is your reason? What is your reason for being here?” says McMacken. “We’re identifying what the reason is really early so we can use that as an anchor as the patient goes through the program.”

Seven months into the program, Torres has seen a real transformation. She lost nearly 20 pounds, lowered her blood sugar, and improved her mood.

“Before I was tired, depressed, sad, in a bad mood, and now I have energy to take care of my grandson, to do my work,” she says.

Now Torres makes a habit of preparing healthy, plant-based meals — swapping meat for tofu, white rice for brown, and adding lots of vegetables. He also changed his relationship with food.

Torres says the program changed her entire relationship with food

“Food is my ally,” explains Torres. “It’s what gives me energy, it’s what gives me health.”

Torres still enjoys some Dominican favorites like rice and beans, but she’s learned how to prepare them in healthier ways.

“For example, I added more yellow and red colors to my plate, which give me fiber and vitamins. I make brown rice with multicolored quinoa.”

Dr. McMacken says a key component of the lifestyle medicine program is helping patients incorporate the foods they already eat into their new diets.

“I think it’s very important to honor and celebrate cultural traditions,” she says. “Many healthy foods are often part of these cultural traditions and can be put at the center of the plate.”

Torres sees a need to expand education and access to healthier foods in her community.

“Spanish speakers, black people, we think that eating healthy is not for us, because we come with the habit of eating differently, of eating fried food,” she explains.

During a recent trip to a health food store, she had a daunting experience after asking a Spanish-speaking employee for help finding ingredients.

“She said, ‘No honey, don’t look for that here. This supermarket is not for us, it is for white people. I felt sad.”

Black and brown communities face the greatest burden of diabetes, in part because there are fewer options for healthier foods and in part because lifestyle support programs like Bellevue are not available at scale wide. In these neighborhoods, diabetes can sometimes be unavoidable.

“There’s this tragic normalization where you’ll just hear people in conversation on the block or in church talking about ‘oh my sugar is acting’ like it’s a sprained ankle or something. You want to try to intervene in the conversation and tell people that it doesn’t have to be this way,” says Spectrum News political anchor Errol Louis, a co-reporter on the show.

When it comes to policy change, Louis says, there is often a leadership vacuum.

“There’s no substitute for somebody, whether it’s a governor or a mayor, a political leader of some kind, to step forward and say this is what we’re going to do and this is why we’re going to do it,” Louis explains. .

One remarkable transformation is a very public one in New York City – that of the current mayor of New York, Eric Adams. Six years ago, Adams was diagnosed with diabetes. He was losing sight in one eye and had tingling in his fingers and toes. Adams took matters into his own hands.

“He went on a plant-based diet and within two months he lost, I think 35 pounds, within six months he reversed the diagnosis,” explains Louis. “And he’s been an evangelist for a different lifestyle ever since.”

Mayor Adams reversed his diabetes by switching to a mostly vegan diet

A longtime advocate for systemic change in health care, the mayor is making Bellevue’s herbal medicine program available at six more sites, with Dr. Michelle McMacken leading the program.

“These evidence-based lifestyle behaviors can have a huge impact, not only on preventing and reducing the risk of chronic disease, but also treating these conditions and, in some cases, even turning things around. Just like Mayor Adams did,” McMacken said at a press event announcing the program earlier this year.

“We have a mayor who was struck by diabetes, who happened to take this course of action, who now thinks he can bring it to scale and use it as public policy. You needed all three of those things to happen at the same time because you have a budget to match,” explains Louis.

Nationally, the CDC estimates that the annual cost of undiagnosed diabetes is more than $300 billion. Added to this is the emotional cost to patients living with chronic illness – and to those who care for them. Adams and McMacken hope the New York program can serve as a model for how public dollars can be better spent to fix the crisis.

“It’s not how much it costs for this program,” Adams said at the press event. “[It’s] how much it will cost us if we don’t have this program. Our health system is not sustainable.”

“We’re pioneers here,” says McMacken. “What I’d like to see is for this to be a household concept, in the medical home and in people’s homes.”

For more, watch Part 1 and Part 3 of Erin Billups and Errol Louis’ joint series on the nationwide diabetes crisis.

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