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Diabetes on the rise
 
Flags placed by students from Goal Academy blow in the breeze at Riverside Cemetery, the oldest operating cemetery in Denver. The students brought the flags on Tuesday, May 21, to place on the side of each veteran’s grave marker to commemorate them on Memorial Day. (La Voz photo by Amber Feese)
 

By Ernest Gurlé
Egurule@lavozcolorado.com
 
05/21/2013

There are a lot of things that inspire audible gasps when learning about diabetes, a medical scourge that haunts the Latino community and grows larger each year. Its costs are astronomical — an estimated $245 billion annually, according to the American Diabetes Association. And, while diabetes can be managed, there is no cure.

There are many causes for diabetes, a disease that falls into two categories — Type 1 and Type 2. Type 1 affects mostly children and young adults. It strikes about five percent of the population. Type 2 diabetes occurs later in life — usually, but not always, in middle age. An increasing number of cases are being noticed among people in their early twenties.

According to the Centers for Disease Control, more than 26 million Americans have diabetes. In 2010, more than 1.9 million new cases were diagnosed in adults 20 and older. But, perhaps, even more alarming is the estimated 5.2 million people who have it and don’t yet have a confirmed diagnosis.

Diabetes is the seventh leading cause of death in America and the leading cause of kidney failure, lower limb amputations and new cases of blindness. And Latinos bear an inordinate proportion of these health issues. At 13.2 percent, diabetes among Latinos is nearly twice as high as the national average.

Diabetes occurs when the body does not produce insulin, a hormone the helps convert sugars and starches — along with other foods — into glucose. Glucose fuels the body. Too little insulin prevents glucose from reaching the body’s cells causing it to use fat for energy. When this happens, it can lead to a condition called ketoacidosis, which can be fatal. An insulin buildup — in the blood and not the cells — can disrupt cell function.

The two most common causes of Type 2 diabetes are obesity and lack of physical exercise. According to the American Medical Association, obesity is defined as weighing twenty percent or more over body mass index. For example, a five foot four inch adult woman with a medium body frame should weigh between 124 and 138 pounds. A five foot nine male should weigh no more than 160 pounds.

Unfortunately, too many people don’t come close to the ideal and many exceed it dramatically. For them, losing weight is a life challenge and the farther from a balanced BMI, the more serious the condition. To live normally, weight loss is essential.

If a person has the means, there are medical options for losing weight. They include gastric bypass or lap band surgery. The former is a surgical procedure that makes changes to the digestive system and aids in weight loss. Famous gastric bypass patients include television’s Al Roker and Roseanne Barr. The latter is the placement of a band around the stomach limiting the intake of food. New Jersey Gov. Chris Christie recently announced he had undergone the procedure.

Both procedures are elective and costly and not always covered by insurance. But today, for Type 2 diabetics in the Denver area there is another option and applicants are now being sought for a trial at the University of Colorado’s Anschutz Health and Wellness Center. And, if selected, there is no charge.

“We have a lot of expertise when it comes to diabetes and obesity,” says Dr. Holly Wyatt, associate director of the Center. Wyatt heads up the clinical trial aimed at helping morbidly obese, Type 2 diabetics lose weight and potentially add to their quality of life.

“If this trial goes well and it shows that it’s effective and safe,” says Wyatt, “FDA may decide to make this available to everybody.” The ideal candidate is a Type 2 diabetic, obese and “having difficulty controlling their blood glucose … they need some help.”

The procedure, called EndoBarrier, involves inserting a tube-shaped liner through the mouth and into the stomach forming a physical barrier between ingested food and a small portion of the intestinal wall. When successful it decreases blood sugar levels and contributes to weight loss.

It involves no surgery and can be performed in as little as fifteen minutes. The device remains in place for a year. There have been 12 previous clinical trials outside the U.S. The procedure has already been approved in Australia.

The trial will be a “double-blind, sham controlled” test involving 500 people who meet the criteria on diabetes and weight. Half of the participants will not actually receive the barrier. But no one, neither physicians nor patients, will know who received it. Both groups are expected to follow post-procedure guidelines and will be monitored for twelve months. At the end of the trial, those who did not actually receive the EndoBarrier will be eligible to receive it free of charge.

Information on the EndoBarrier trial can be obtained by calling 1-888-978-8399 or at www.endobarriertrial.com.

For Type 2 diabetics not selected or who never learn of the trial, there is a different kind of treatment and, if faithfully followed, says Dr. Chris Urbina, Executive Director of Colorado’s Department of Public Health and Environment, can also produce results. Its success, however, depends on discipline.

“There is no reason why we can’t eat healthy,” says the Pueblo native. But, too often, “there is a ‘fatalismo’ in our community.” People, Urbina says, especially Latinos, chalk up their fate to “God’s will.” “That is true. But God also wants you to be healthy.”

Factors that play into the disproportionate ratio of diabetes among Latinos include income, diet and lack of exercise. “Comida natural is healthy; fresh fruits and vegetables, exercise, there’s no reason why we can’t be healthy. Chicharones (fried pork rinds) on a regular basis are probably not a healthy option.”

State health will soon begin a program aimed at healthier lifestyles — prevention of diabetes and obesity — with a particular emphasis on lower income individuals and minority communities. It will involve coaches and counselors who will help people make healthier choices, “how to read labels, how to cook healthier, how to make all the good choices and then follow them over a 16-week program.”

Urbina says it will be a challenge, particularly since the state can’t match the marketing budgets of food and beverage giants who daily bombard media — including on-line media — with campaigns promoting “sweetened drinks, unhealthy foods.”

A new way of thinking — public campaigns in schools and communities — is already having a positive impact, Urbina says. School menus and community gardens are shifting the focus on healthier lifestyles and better choices. “Kids are getting into a healthy habit of wanting to eat fresh fruits and vegetables so that when they go home they can ask for them.”

But fruits and vegetables and healthier foods are sometimes beyond the budget of lower income families. “If you are in a lower income, you can’t always make the choice — but you can grow your own during the summer.”

Urbina says communities including “Barnum, West Barnum, Sun Valley on the westside; Globeville, Swansea, Elyria on the eastside,” all have community-based gardens.

More than six percent of Colorado’s population, including more than 50,000 Latinos, has diagnosed diabetes. But, it need not be this way, says the veteran and native Colorado physician. Better choices and healthier lifestyles can and do make a difference.

 

 

 

 

 
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