Learning from the Patients: An Interview with Diabetes Expert George L. King, MD

Elizabeth Michaelson Monaghan

Reviewed by QualityHealth's Medical Advisory Board

Diabetes is a national epidemic: More than 29 million Americans—9.3% of the population—have the condition. Another 86 million are at risk of developing it, according to the American Diabetes Association. In 2012 alone, 1.7 million new cases were diagnosed. Currently, diabetes is the seventh leading cause of death in the US.

But it wasn’t always so common, according to George L. King, MD, the research director/chief scientific officer at the Joslin Diabetes Center in Boston and professor of medicine at Harvard Medical School. "Type 2 diabetes has really skyrocketed in last 20 years in every ethnic group in the country," he notes. (About 95% of diabetes patients have type 2 diabetes.) "Obviously there are genetic contributions [to the development of the disease], but it’s environmental and lifestyle changes [like increases in calorie consumption and decreases in physical activity] that have caused this explosion."

In a recent interview with QualityHealth.com for National Diabetes Month, King, the author of The Diabetes Reset (Workman, 2015) discussed the outlook for type two diabetes patients, the latest trends in prevention and treatments, and how patients can get a better handle on the condition.

Trends in Diabetes Prevention, Treatment, and Outcomes

Since his arrival at Joslin in 1981, King has seen many changes in the diabetes landscape. Knowledge of the condition has increased, and today, "I think awareness is high—there’s a new article about diabetes almost every week in the major newspapers. The issue now is what can we do about it," King says. "Lifestyle changes—even fairly small changes—can make a difference over the course of a year."

And for patients, the outlook is better than ever: "Over the last 10 years we’ve seen all sorts of new treatments for type 2 diabetes, including three new classes of drugs," King says. Meanwhile, "For type 1 patients, there’s new types of insulin (including a newly-approved inhalable version), and injections are not so onerous these days: The needles are so thin, it doesn’t hurt. And with the glucose monitor, you don’t have to stick yourself all the time, just once every four days or so."

People with diabetes are also living longer: "It used to be that many people with diabetes lived for about 20 years" after a diagnosis, according to King. "But now we’re seeing people who are living so much longer." This has enabled researchers and clinicians to learn more about the long-term health issues patients may face. "We’re seeing more research into the links between diabetes, cancer, and Alzheimer’s, but we don’t yet know enough about the possible connections."

Complications

While more patients have better control over their diabetes and fewer develop complications like eye diseases (diabetic retinopathy) or blood vessel problems, which can lead to heart attacks and stroke, the sheer number of people diagnosed with diabetes means that complications are still too high, King points out.

A sign of advanced disease, "Complications take years to manifest, and may take years to improve," he explains. While maintaining control of your blood sugar can help prevent or lessen complications, King says that patients who improve their diabetes may not immediately see improvement—in fact, they may first experience the opposite. With improved blood sugar control, "The disease is not getting worse, but the symptoms may get worse" for a time. For instance, in patients with neuropathy (nerve pain or damage), "The nerves are used to high glucose, so with lower glucose [and better blood sugar control], you may actually feel more pain as your nerves recover; you may experience more symptoms for two to three months."

Learning from Patients

People with diabetes play an important role in new developments. "Everyone talks about discoveries in the lab, but we learn from the patient," King notes. "We take that learning to the lab, to design treatments, and then we go back to the patient." For example, in recent years researchers have found that the protein vascular endothelial growth factor (VEGF) is a cause of eye disease and loss of vision in people with diabetes. Patients drove this breakthrough: "VEGF was initially discovered in fluids from diabetic patients. And today, there are new treatments that help prevent blindness."

In addition, thanks to patients, researchers have "Rediscovered that brown fat [a particular type of body fat] exists in humans. Now we’re studying its role in inflammation, and hopefully we’ll be able to stimulate brown fat in patients."

What Patients Should Know

King stresses that many diabetes patients have a degree of power over their own futures: "You can do something about diabetes," he says. By making lifestyle changes, particularly in the areas of food, activity, sleep, and stress reduction, "Patients can control the disease, manage it, and in some cases, even reverse it."

How can patients improve their condition? Most people know that it’s important to eat right and exercise, but "People really need to work with their healthcare providers to come up with a custom program. It’s useless to say 'Eat well and lose weight,' without telling patients how to do this." In addition to discussing options with your doctor or diabetes educator, King offers these tips:

Move more. Experts recommend getting 30-50 minutes of physical exercise three to four times a week. But as King points out, you don’t have to train for a marathon to reap the benefits. Instead, "take the stairs, walk for 45 minutes to an hour a day—walk the mall if you like going to the mall, walk with a group!"
Downsize your portions. A recent trip to Portugal reminded King that servings don’t have to be huge to be filling: "You don’t have to serve pasta on a 12-inch plate."
Get friendly with veggies. High fiber vegetables are filling and nutritious. But you don’t have to eat broccoli if you loathe it: "Choose the types of vegetables you like, and get interested in cooking," King says. By exploring different cooking methods, such as flash-heating (quick cooking) and roasting, you won’t have to choose between healthy but humdrum raw cauliflower and tasty but bad-for-you deep fried potatoes.
Take your time. King urges patients to be patient as they develop healthy new habits: "The expectation is that there will be an immediate improvement, that patients can lose 20 pounds in one week." But this isn’t really realistic. Just as "It takes a long time to develop diabetes, you may not seem immediate improvements" after making changes.

"Diabetes is a lifelong process, and the changes you make should be long-term," King says. "You have to enjoy these routines, too, otherwise you won’t do them. These lifestyle changes have to be fun, and pleasant!"