Trends in the Ongoing Diabetes Epidemic
Sep 09, 2021
Trends in the Ongoing Diabetes Epidemic
Programs in Johnson County support patients in lifestyle modifications and self-care in diabetes management
By Betty Drees, MD, FACP, FACE
Diabetes mellitus is no doubt one of our greatest global health concerns.
A study published in the June Journal of the American Medical Association using data from U.S. adults showed that the estimated prevalence of diabetes increased significantly from 9.8% in 1999 to 14.3% in 2018. Only an estimated 21% of adults with diagnosed diabetes achieved control goals for three important risk factors to reduce complications in 2015-2018, including individualized hemoglobin A1c targets, blood pressure less than 130/80 mm Hg, and low-density lipoprotein cholesterol level less than 100 mg/dL.
These disturbing findings are concerning as risk for associated complications increases. Add COVID-19 into the mix, and the risks increase as people have delayed care for diabetes and screening for diabetes have decreased. The pandemic spurred weight gain for many adults who were inactive, and decreased access to health screenings in peak phases of the pandemic, creating a care gap for a growing number of individuals who have diabetes but don’t know it.
In short, we have a lot of work to do to identify those at risk for diabetes, reduce risk of complications, and implement standards of care for people with diabetes.
There is encouraging news. Although the risk of cardiovascular disease is two to four times higher in people with diabetes and is the leading cause of death in diabetes, the rate of death from cardiovascular disease has decreased significantly over the past two decades, largely due to better blood pressure control and the use of statins. And now we have two new classes of diabetes medications that have cardiovascular benefit aside from the effect on glucose control, namely SGLT2 inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists. Based on cardiovascular outcomes studies, the FDA continues to approve new drugs in these two classes.
These drugs have been a game changer in algorithms for the clinical management of patients with diabetes. Updated regularly, the standards of care are available on the American Diabetes Association and American Association of Clinical Endocrinology with easy-to use-diabetes management algorithms. These algorithms incorporate use of SGLT2 inhibitors and GLP1s much earlier in the management of those at increased risk of cardiovascular complications, but also guide choices of drugs based on cost, risk of hypoglycemia, weight management, etc.
As with most chronic diseases, diabetes requires both medical intervention and self-management, including lifestyle modification. Lists of regional, certified diabetes self-management programs can be found through the American Diabetes Association and The Association of Diabetes Care & Education Specialists.
Identifying people at high risk for developing diabetes is important for two reasons: first, they are at increased risk of cardiovascular disease even if they don’t yet have glucose levels high enough to diagnose diabetes, and second, structured lifestyle intervention programs are effective in preventing diabetes and reducing cardiovascular risk. In Johnson County, The Live Well Johnson County initiative through the Johnson County Department of Health and Environment offers the Diabetes Prevention Program, a year-long evidence-based self-management program for prediabetic adults. Programs are offered throughout the county. To learn more contact Anne Hayse anne.hayse@jocogov.org
The American Heart Association Kansas City affiliate has a variety of resources, including the Move More Together exercise initiative, and the “Check Change Control” program to track and manage blood pressure. Contact erin.gabert@heart.org to learn more about local resources.
Betty Drees, MD, FACP, FACE, is a professor of medicine and Dean Emerita at the University of Missouri-Kansas City School of Medicine, Department of Internal Medicine and Department of Biomedical and Health Informatics. She is also president of the Graduate School of the Stowers Institute for Medical Research.
Diabetes Management Opportunities in the Kansas City Area
Opportunities to connect patients with health promotion and recreation activities are available throughout the metropolitan area. Here are a few:
Health Promotion for Patients
Health Departments
- Johnson County – https://www.jocogov.org/dept/health-and-environment
- Wyandotte County – http://www.hcwyco.org/what-we-do-2
- Kansas City, Mo. – http://bit.ly/kcmo-health
- Jackson County – https://jacohd.org/initiatives/building-a-healthier-jackson-county
- Clay County – https://www.clayhealth.com
- Centers for Disease Control and Prevention – National Diabetes Prevention Program – https://www.cdc.gov/diabetes/prevention/index.html
Community Organizations
- American Diabetes Association – https://diabetes.org
- American Heart Association Kansas City – https://www.heart.org/en/affiliates/kansas/kansas-city
- YMCA/Diabetes – http://bit.ly/ymkc-diabetes
- YMCA/Chronic Disease Management – http://bit.ly/ymkc-chronic
- Kansas State University Research and Extension – https://www.johnson.k-state.edu
- Area hospitals also offer a wide range of health education and promotion programs.
Walking & Bicycling Trails, Recreation Programs
Providing patients with the Johnson County Park and Recreation District’s comprehensive trail guide is an easy way to encourage physical activity at no cost to the patient.
- Regional – http://bit.ly/KC-trails
- Johnson County – https://www.jcprd.com/592/Trail-Guide
- Johnson County 50-Plus Program – https://www.jcprd.com/170/50-Plus
- Wyandotte County – https://www.wycokck.org/Parks/Recreation.aspx
- Kansas City, Mo. – https://kcparks.org/about-recreation/trails/
- Jackson County – https://www.makeyourdayhere.com
- Clay County – http://bit.ly/clay-trails
Resources for Physicians
- Show-Me ECHO (Extension for Community Healthcare Outcomes) – Includes bimonthly CME sessions on diabetes, pediatric weight management, and other topics. https://showmeecho.org/
- American Association of Clinical Endocrinology – https://www.aace.com/
- American Diabetes Association (standards of care; list of certified diabetes education programs) – https://diabetes.org
- JDRF Kansas and Missouri Chapter
- Centers for Disease Control
- The Association of Diabetes Care & Education Specialists (list of certified diabetes education programs) – https://www.diabeteseducator.org/living-with-diabetes/find-an-education-program
To Members of the Kansas City Medical Society: Greetings, My name is Greg Unruh , and I am honored to be the President of the Society for 2024. By way of a short introduction, I practice anesthesiology at the University of Kansas Medical Center. I have been involved in and have held leadership positions in local, state, and national societies of organized medicine throughout the years, both in anesthesiology and non-anesthesiology societies. I was an officer in the Wy-Jo Medical Society when we merged with the Kansas City Medical Society and have remained on the Board throughout all of the reorganization. I am very proud of how far we have come, It has put us in position to speak for physicians on both sides of the state line. We have expanded our Leadership Council, and we have passionate members of our Board of Directors. I want to commend our Immediate Past President, Dr. Carole Freiberger for her leadership in 2023. She provided us with an optimistic, can-do Presidency that advanced the Society and the practice of medicine in the KC area, so thank you Carole! In addition, we have welcomed the steady leadership of our executive director, Mr. Micah Flint. We appreciate him keeping us on track and organizing our many activities. Several of the things I mention will be dealt with in more detail throughout this communication, but I wanted to highlight some the several areas the Board has chosen for our work this coming year: Advocacy We want to advocate on both sides of the state line working with both the Missouri State Medical and Kansas Medical Societies (MMSA and KMS) on behalf of physicians. On the Kansas side, the legislature is working on many issues that affect us including scope of practice, vaccinations, Medicaid reimbursement and Medicaid expansion. We are working with KMS to provide testimony and influence our legislative representatives. Support for our Foundation We want to support our crown jewel whole heartedly, the Kansas City Medical Society Foundation which continues to be a model for advocacy and education, as well as our charitable care program which provides immense benefits for our uninsured or under insured patients. The Foundation supported expansion of Medicaid on the Missouri side and is advocating tirelessly for expansion on the Kansas side. Ms. Karole Bradford is our Executive Director. Opioid abuse We have been working to help stem the tide of opioid abuse through education and visibility. We are in the process of putting together TikTok videos about the dangers of opioid abuse produced by local high school students and targeted at high school students at their level and their preferred communication platform. We also have activities targeted to school district officials and several of our Board members and members provide advice around opioid use disorder and school policies. Wellness and Suicide Prevention Our focus has been on removing the stigma that sometimes attaches to physicians help-seeking. We have been advocating for health systems and hospitals to remove credentialing language that could impede a physician from seeking help. Several systems are reviewing their language and are now trying to focus on current, not historical, mental health issues or substance use that could affect safe practice. We are also working to participate in Physician Suicide Awareness Day in September. Welcoming New Members If you are a current member, thank you! I hope you have found our activities to be meaningful for you and your practice. Please consider asking your colleagues to join our collective voices. If you are not a member, please consider joining-we’d love to have you! In conclusion, I’m excited about the year to come and look forward to hearing any and all thoughts and ideas for the Society moving forward. Thanks, and best regards, Greg
Congratulations to our 2023 Kansas City Medical Society Medical Student Scholarship Recipient
2023 Annual Meeting: An Amazing Event!
