In part 5 of this Exclusive Interview, Dr. Jeffrey Mechanick talks with Diabetes in Control Publisher Steve Freed during the AACE 2018 convention in Boston, MA about the need for lifestyle medicine in treating diabetes, and how new multidisciplinary approaches are balancing nutrition vs physical activity in diabetes care.
Dr. Jeffrey Mechanick, MD, FACE, FACR, FACN, ECNU is the Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease at the Icahn School of Medicine at Mount Sinai, NY.
Transcript of this video segment:
Freed: When you sit down with a patient, you only have so much time. You have to put emphasis on something. Certainly medications. In looking at physical activity and nutrition, I always like to ask the question: Give me a percentage of the importance; is it 80 percent nutrition, or is it 50-50?
Mechanick: The best answer to that question is we do not know, but, we do not know for a good reason. The reason is, is lifestyle medicine has really received short shrift when we look at the whole portfolio of interventions for chronic disease. Hopefully that is something that will change and we’ll be able to answer that, and put together the right prescription and cocktail. But let me just fast-forward a little bit to tactics and implementation and time constraints and the world we live in. What we really need are well-equipped centers and practices to help manage chronic disease. Now you can find this in the AACE chronic care models for diabetes and obesity where not only do you have patient activation as an initial process but also, a prepared practice as an initial process. So, for instance, in this center that we have developed at Mount Sinai, we actually have a gym right there where the doctor’s office is. We have exercise physiologists, we have the nutritionists, we have the certified diabetes educator, and it’s all there with various economic models so that patients cannot only afford it but also, it’s available and we have evidence-based protocols to really pull all this together as seamless as possible. I would assert that this type of multidisciplinary approach to structured lifestyle, not mutually exclusive with the pharmacotherapy, and not mutually exclusive with procedures or various surgeries. This is all part of the toolkit that we have to manage chronic disease. This is all about chronic disease; it’s not about the acute DKA (diabetic ketoacidosis) episode or amputation of a foot or the acute MI (myocardial infarction). This is about prevention – preventing those complications and preventing the serious morbidity, the impact of quality-adjusted life years (QALYs), disability adjusted life years (DALYs) – all the metrics we have for chronic care. That is what is making our general population unhealthy – that’s what’s compromising the wellness and this is where we need to refocus our attention.