Dr. Martin Abrahamson is the author, with Dr. Sanjiv Chopra, of the new book Conquer Your Diabetes. He is an associate professor of medicine at Harvard Medical School.
Q: You write, “Diabetes is a major health issue whose global prevalence has reached alarming levels.” Why do you think it has reached these levels?
A: The prevalence of diabetes continues to increase worldwide. In the United States there are now 96 million people with diabetes, 95 percent of whom have Type 2 diabetes.
This increase in prevalence parallels the rise in obesity in the United States and worldwide. While there may be some genetic predisposition to type 2 diabetes, changes in lifestyle—decreased exercise, poor dietary habits—and increasing weight gain/obesity are the major reasons for the increase in the prevalence of this condition.
Q: What do you see as some of the most common perceptions and misconceptions about diabetes?
A: People think that slight elevations in glucose are harmless. This is wrong. We know that mildly elevated glucose levels can lead to complications in the long term. This is why some of the complications of diabetes are present at the time of diagnosis of Type 2 diabetes.
Hence it is important to screen for diabetes—it is recommended that anyone over the age of 35 be screened for diabetes, and that screening begin sooner if there are risk factors for Type 2 diabetes, e.g. family history, overweight or obesity, history of gestational diabetes, a condition called polycystic ovarian syndrome, high blood pressure, abnormal cholesterol levels, and people who belong to certain ethnic minority groups where we know the prevalence of diabetes is higher.
Another misconception is that it is difficult to control diabetes. This is not the case. For people with Type 2 diabetes small amounts of weight loss can improve glucose control. In addition. there are newer medications that are safer and very effective in terms of glucose lowering.
Q: What are some of the most promising advances in treating diabetes in recent years, and what do you see looking ahead?
A: For people with Type 2 diabetes, they are newer medications that not only lower glucose but also facilitate weight loss and reduce the risk for cardiovascular disease. Cardiovascular disease remains the commonest cause of death in people with diabetes.
For people with Type 1 diabetes there are better insulin therapies—insulins that have been modified to either work more quickly to cover meals or have longer duration of action to effectively control glucose between meals and overnight.
There are better glucose monitoring systems (glucose sensing devices that continually measure glucose without the need to do fingerstick testing), and much improved insulin delivery systems including “smart pumps” that are able to adjust the delivery of insulin based on the glucose levels.
Q: What do you hope readers take away from the book?
A: Hope and empowerment. Our goal is to inspire people who have diabetes or are at risk for diabetes, and help them realize that diabetes does not control them, but rather that they control their diabetes.
Diabetes does not define who you are. There is nothing a person with diabetes cannot accomplish. We include many stories of our patients who have inspired us –who have risen to the challenge—and who lead fulfilling lives.
We also include a chapter on stem cells; use of stem cells to cure people with type one diabetes is on the horizon.
We also want readers to realize that lifestyle modification plays a major role in the self-management of diabetes, but there is not “one size fits all” when it comes to the right diet. We include chapters on coffee and the microbiome to provide readers with new insights.
And we talk about the liver and diabetes; the commonest cause of end stage liver disease in the United States today is fatty liver disease or nonalcoholic steatohepatitis. Fatty liver is associated with a condition called insulin resistance which plays a major role in the causation of Type 2 diabetes.
Q: What are you working on now?
A: We are looking at ways to make this a “living book.”
Q: Anything else we should know?
A: Almost one-third of the United States population is at risk for or has diabetes. Our hope is that anyone who fits into this category and who reads the book will become more empowered to take steps to improve their health.
--Interview with Deborah Kalb
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