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Nancy D’Hondt Part 3, The Epidemic Of Prediabetes

In part 3 of this Exclusive Interview, Nancy D’Hondt talks with Diabetes in Control Publisher Steve Freed about the current efforts to push preventative care and what might be needed to reach more people at risk for prediabetes.

Nancy J. D’Hondt  RPh, CDE, FAADE is an ICU pharmacist in the St. John Health System in Detroit.


Transcript of this video segment:

Freed: And one of the big things, and I don’t hear too much discussion about it, is that we know there’s 30 million people with diabetes, 10% of them are type 1s. But we know there’s approximately, and we’re just assuming with the numbers that we have, that there’s probably close to a 100 million people with pre-diabetes that are on their way to becoming diabetic. And if we’re  spending $360 billion today for the 30 million, what are we going to spend for 100 million when they start to lose their limbs and their kidneys? I just can’t comprehend why we’re not doing anything. And I don’t even know that even AADE from my experience is really pushing that aspect. I mean, if it was me I would have every person filing an income tax return have to fill out one of the American Diabetes forms that detects whether you’re at risk for diabetes by filling in five little squares with numbers or check marks that we could — I mean, why isn’t that being done?

D’Hondt: So, it is. So, we have prevention programs. We’re working with the CDC. They resurrected the data from the DPP and did some studies with the National DPP Program trying to roll it out. We have had a five-year contract. Our outcomes data that we reported to them under the original grant were as good if not better than what the health coaches — that was the Y programs and the programs that were accessible in the communities. And we wanted to compare community with life coach trainers compared to lifestyle coach trainers that were actually CDEs or experienced diabetes educators. Our outcomes data is good. We re-upped. We have another grant going with the CDC. I think the biggest barrier is because — and I listened to a talk yesterday. It’s like running out of gas or changing your oil. If you run out of gas, you have an immediate effect. Your car stops. You don’t go any further. That’s a problem. So, you have to take care of it. You don’t run out of gas. You’re conscious about it. Your oil, you don’t have an immediate effect if you go beyond the marker of having to change it. So, people with chronic diseases, there’s not an immediate effect for them not taking care of it, unless maybe you’re a type 1. But for most patients with chronic diseases, there’s not an immediate effect that they feel differently or poorly all of a sudden, so they push the envelope. And if I don’t feel bad or bad enough to go to see a health care provider, I’m not going to take care of it. I think the same thing is with DPP. It creeps up on them until they are broken. And we don’t have an initiative nationwide to really push the prevention envelope. We talk about it but we don’t practice it. And even with self-referral for the Medicare patients, they’re not bringing them in. I don’t think we’ve explored the avenues for giving them the value-based proposition behind it. I don’t think that we’ve partnered with, for instance, the AARP. They have a big influence on seniors and those who have Medicare. But AARP is not pushing this out to their seniors and letting them know. We’re not going into the senior centers and providing programs. We’re not going to where they live and where they hang. So, I think we really to look at where are the access points for them and making it accessible for them rather than waiting for them to come to us. And I think that’s some of what we’re looking at.

Freed: That’s interesting because what you’re talking about is educating people with pre-diabetes. What I find is that that’s only 10% of a 100 million. The other 90 million have no clue. They don’t even know they have pre-diabetes and that’s really where the impact needs to be as far as educating enough public that they have pre-diabetes. If we sent that form out, it’s available on ADA with every tax return, or every drivers license you have to go — you have to have an eye test, we have a diabetes test. I mean, to me that’s so simple. It’s stupid.

D’Hondt: That’s a good idea. (Laughs)

Freed: That if 90 million people knew they had a disease called pre-diabetes, I guarantee you half of them would take a more active role in going for a walk. The American Diabetes Association should sponsor, get a dog. I mean, there’s so many ways we could do it. We’re so focused in on the cure for type 1 or cure for type 2 that we lose aspect, that the real problem is not even here yet.

D’Hondt: We’re not stopping the wave that’s coming behind the tidal wave.

Freed: And I can understand why because when it comes to diabetes there’s so many things involved; you’ve got kidney issues, you’ve got eyesight, you’ve got neuropathy. There’s just so many things that everybody is working on, that we don’t have time to worry about pre-diabetes. We’re going to wait until it’s a trillion dollar business.

D’Hondt: We’re trying but it’s just — I don’t think there’s a big enough push. I think that it has to be a multi-organizational, multi-institutional, as in government has to stand behind this and really help push this because you know that diabetes is the underlying cause of a lot of these other chronic disease. Heart disease, 80% of those patients that have heart disease have diabetes. But heart disease gets a lot of attention and diabetes gets put on the back burner. Why is that?

Freed: Well, what I’ve done in the past is really push A1C numbers. And I know it’s not messiah to everything but I call it the quality of life test, because that number determines when you’re going to live or die. That number determines your risk factor for every disease known to man whether it’d be athlete’s foot to dry skin. Somehow because sugar is attached to every red blood cell and the red blood cell is everywhere in our bodies, that it affects our whole immune system and increases our risk for all kinds of things including cancer and Alzheimer’s and all those wonderful diseases. So, I try to push A1C that everybody on this planet should have, know what their number is. And if you know what your Social Security Number is you should certainly know what your A1C is. And once you know what it is and what it represents and how that increases your risk for every disease known to man, then it’ll motivate people and I’ve proven that. I went to the electric company in Illinois. They asked me to come in and do a presentation to their employees. And so, I went to this plant where they had 200 employees. And I did a presentation every eight hours, there were three eight hours shifts because they worked 24 hours, talked about the importance of the A1C. And I offered, they paid for it, I offered to do an A1C test after my presentation. And I had all 200 waiting in line wanting an A1C test. And first time in my life, I worked 24 hours straight with no bathroom or eating breaks doing A1C. The next time, because I went to three plants, I brought two people with me. But the first time I never thought — so the point is that if you present the information properly or motivate them, they’ll want that number.

And then I came back 90 days later to review the A1C, I dropped the A1Cs 40% because most of the people were overweight, they’re in their 40s, 50s, 60s. They’ve been around for a long time and their A1Cs were elevated. It’s around 30% with pre-diabetes, but I didn’t even really promote the diabetes aspect. I promoted that quality of life concept that this number represents how well your health is. And like I said I dropped the average A1C about 40%. And they asked me to come back to do it for their other plants and — but then I learned after that year I said, “You know what, I’m not going to charge you a fee. I want half of what I saved on your medical expenses,” because I had to save millions of dollars. So, I think as you do presentations and the diabetes educators are more actively involved that they all have great ideas, because they’re dealing with the problem and they could see where the areas are.

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