Traverse City Record-Eagle

July 14, 2013

Diabetes in the region at 15.2 percent


---- — TRAVERSE CITY — The incidence of diabetes is increasing so fast that a Munson Healthcare initiative has aimed not to reduce it, but to simply put the brakes on its skyrocketing growth.

“The rates are increasing so significantly, it’s estimated that 33 percent of Americans will be diabetic by 2050,” said Jill Vollbrecht, a physician who specializes in diabetes, metabolism and endocrinology.

Vollbrecht is a medical co-director of the Northern Michigan Diabetes Initiative, a partnership recently honored by the Michigan Health and Hospital Association.

The Grand Traverse region has a diabetes rate of 15.2 percent, compared to the national rate of 8.5 percent. The reason:

“We’re fat, and we’re old,” Vollbrecht said. “Honestly.”

Michigan ranks as the fifth fattest state with 65.5 percent of its citizens overweight or obese. The five-county area weighs in at just over 68 percent overweight.

The region also has grown older and includes a small percentage of American Indians and Hispanics, who are more prone to insulin resistance, which leads to Type 2 diabetes, Vollbrecht said.

The diabetes initiative started in 2006 when the top chiefs of Munson Healthcare and Priority Health Insurance decided to combine efforts to improve community health, said Diane Butler, Munson's community health manager.

The initiative has since grown to include 12 counties, Munson’s affiliated hospitals, public schools, health departments, and other entities, she said.

Vollbrecht became involved, in part, because there are far more diabetic patients than she and fellow endocrinologist John Faichney can treat.

“So we had the discussion of how can we educate primary care providers to manage their diabetes patients,” she said.

They came up with an idea of teaching primary care doctors, one-on-one, on how to best treat diabetics. The program began in 2011 with nine doctors.

“After that session I would see four patients with a provider, each with a different type of diabetes,” she said. “We’d see the patient together, debrief, go over the case, and come up with treatment plan.”

Data showed the test patients improved their cholesterol management and kidney function, but there was no statistical significance in overall diabetic care, said Vollbrecht, who recently presented her findings in Chicago.

Obesity is linked to Type 2 diabetes because fatty tissue produces hormones that can cause insulin resistance. That triggers the pancreas to pump out more insulin to keep blood sugar levels at a normal level.

“For awhile the pancreas just pumps out more insulin and keeps up with the demand,” Vollbrecht said. “But after awhile, it doesn’t keep up, and the blood sugar starts to rise.”

High blood sugar can lead to blindness and kidney failure, increase the risk of heart attack and strokes, and damage nerve endings, which causes tingling and numbness in the feet.

Vollbrecht recommends patients to lose 5 to 10 percent of their weight — a doable goal. Lose enough weight, she said, and blood sugar will normalize.

"But the diabetes doesn't go away. If you gain the weight back, the diabetes will come back," she said.

Vollbrecht’s efforts are just one element of the diabetes initiative that also includes an array of outreach and awareness efforts.

A particular challenge, Butler said, is that food pantries tend to stock high-carbohydrate foods that exacerbate diabetes.

“You can’t take an all-or-nothing attitude,” she said. “ … (W)hen you get a big box of spaghetti, just don’t eat the whole box, but a part of it. If you get a can of peas, realize it’s not inferior to the farmer’s market. If that’s what you can get, please don’t throw it away.”