A New Approach to Diabetes Care in UtahJun 13, 2014
Diabetes has become a national epidemic, and in Utah alone it is expected that one in three will have diabetes by the year 2050. As new chief of endocrinology and co-director of the new Center for Diabetes and Metabolism, Dr. Simon Fisher will be leading an initiative to tackle this problem, including re-envisioning diabetes care and prevention.
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Interviewer: Diabetes has become a national epidemic, and in Utah alone it's expected that one in three will have diabetes by the year 2050. My guest, Dr. Fisher, chief of endocrinology and co-director of the new diabetes and metabolism center, will be leading an initiative to tackle this problem head on. Diabetes is not exactly a new problem anymore, and the one thing that's striking to me is that it's still on the rise despite public awareness and despite the fact that the health care providers are being increasingly proactive.
Dr. Fisher: Well, the system's not broken. Eighty-five percent of the people with Type 1 diabetes, what we used to call juvenile diabetes, are now adults. Kids get diabetes often in their teens. They progress to adults. A lot of Type 1 diabetics are adults and living longer lives and healthy, productive lives.
Also, Type 2 diabetes has become an epidemic with the abundance of supply of food, lack of nutrition, lack of exercise. We're eating the wrong foods and not getting enough exercise. It's become an epidemic out there.
We need to intervene to stop this epidemic of diabetes. There's a high, high cost associated with diabetes care. That's why it's in the federal government's best interests, the university's best interests, and the hospital's best interests to take care of people with diabetes to prevent them from having associated complications - retinopathy, neuropathy, kidney disease.
Interviewer: You're coming here to Utah to help start a diabetes center.
Dr. Fisher: Yeah. I'm here as the incoming chief of endocrinology, and we're charged with the mission of improving diabetes care for people in Utah.
Interviewer: Why in Utah? There are some pretty well known diabetes centers across the country already. Why have one here?
Dr. Fisher: Diabetes remains a big problem here in Utah. There are about 135,000 people who have diabetes. A lot more of them are undiagnosed. More than three times that number have pre-diabetes and are at risk of diabetes and getting diabetes associated complications. Something needs to be done here.
Also, I'm excited to be moving here because this city and state is number one in the country for philanthropy. We're looking forward to partnering with people who might have the means to help support a diabetes research mission.
Interviewer: You see patients, correct?
Dr. Fisher: Absolutely.
Interviewer: Do you feel that there's an improved future for them?
Dr. Fisher: Absolutely. I mean nobody likes being told they have diabetes. From a physician's point of view, we see patients. Our goal is to improve their lives, to improve the quality of their lives.
I had one lady who came in to see me. She was about 400 pounds overweight. She was on ten different medications, several for her diabetes. She was maxed out on all her blood pressure and cholesterol medications. Her blood sugar was completely out of control.
At that point she came to see me, the specialist. I was sort of laughing, because I thought you're on every medication known to mankind, what can we do. I suggested the possibility of bariatric surgery. She hadn't heard about that. I mentioned it was the stomach surgery.
I saw her just a few weeks ago. She had lost over 200 pounds. She was now off all her medications and was doing great. Sometimes it's just a matter of getting people and pushing them in the right direction, and in extreme situations and perhaps not extreme situations, sometimes surgery is the answer. Again, it's exciting to see people do well when they take medical advice.
Interviewer: If I am a diabetes patient who's coming to the University of Utah for treatment, how might my care change?
Dr. Fisher: There's no question that people who see their doctors, and educators, and nutritionists, and exercise physiologists, and pharmacists, if you have a whole team of people taking care of your diabetes, your outcome is going to be a lot better than if you didn't. There's no question. Study after study after study have shown that people who are engaged with their own diabetes care, and not just go and see their doctor once a year or once every couple of years, people who see their doctors regularly and follow a routine do better.
What we're planning on doing here is we're initiating a care network and care algorithm by which we're getting our patients here to see a doctor or a nurse practitioner, and then see a dietitian, and then see an exercise physiologist, and then maybe other referrals to an eye specialist or kidney specialist. We're writing algorithms now so that we can help all the doctors in our system have a standard way of treating diabetes and looking after people with diabetes. That way it's streamlined and the patient's on board and knows where they're going, what the goals are, and what the outcomes are going to be.
Again, the more care you get the better outcomes you get, and you can prevent a lot of the diabetes complications with appropriate diabetes care.
Interviewer: It seems like by the time you're seeing a specific clinician who treats diabetes, then it's almost too late, right? It seems like you need to integrate this movement into the general health care system.
Dr. Fisher: Yeah, I agree with you. By the time they see me, the diabetes specialist, they're well into their diabetes.
One of the things we're doing planning on is an outreach program into the community, outpatient clinics. We're going to get there, and a lot of it has to do with getting our diabetes educators and diabetes specialists to raise awareness of diabetes. We've shown that with diet and exercise, something that sounds simple but is hard to initiate and get people on board with, but if we can that's going to prevent a lot of diabetes in the future.
We want to nip this in the bud. Again, the more we prevent, the less problems we're going to have down the road in terms of treatments and complications of diabetes.
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