It makes sense to check in now with Kirk Kerkorian School of Medicine at UNLV's Dr. Kenneth Izuora and Dr. Sanna Fatima, physicians dedicated to wiping out diabetes – November is American Diabetes Awareness Month, a time when the CDC estimates that a staggering 38 million Americans of all ages have the endocrine disorder commonly known as diabetes.
What Izuora – he’s the head of the school of medicine division of endocrinology while Fatima is in the first year of an endocrinology fellowship – has to say about a disorder that annually accounts for more than 100,000 deaths in the U.S. is disturbing. He’s well aware of alarming statistics associated with the disease that results in 150,000 amputations each year in the U.S. and is a leading cause of blindness, kidney failure, heart attacks, and stroke.
“The rate of diabetes in the U.S and Nevada is increasing,” says Izuora, whose passionate fighting of the diabetes epidemic went a long way toward the internal medicine department and graduate medical education office supporting his founding of an endocrinology fellowship at the medical school four years ago. “The American Diabetes Association (ADA) estimates that over 260,000 people, more than 10 percent of the Nevada population over 18 years of age, have diagnosed diabetes and another 70,000 are undiagnosed. The estimated cost associated with diabetes in Nevada, according to the ADA, is $2.8 billion every year.”
Fatima, a Pakistani immigrant who completed her internal medicine residency at the Albert Einstein Medical Center in Philadelphia, says her grandmother’s death from diabetes had much to do with her pursuit of a career in medicine. The increasing number of people around the world with the disease – the World Health Organization says the number of people who died with diabetes and kidney disease due to diabetes rose to 2 million in 2019 – further served to convince her to specialize in the care of people with the disorder as well other endocrine conditions. (Both Fatima and Izuora estimate about half their patients have diabetes).
“My passion for medicine began in my childhood when I witnessed the tragic consequences of inadequate healthcare,” Fatima says. “This happened when I was in the second grade. My grandmother, who lived in a rural village, suffered from diabetes and kidney failure. She did not have access to proper medical treatment or diabetes education. No doctor took the time to explain to her the lifestyle changes she needed to make to control her diabetes better. This led to her kidneys failing and she passed away at age 60. Her death left a deep impression on me, and I vowed to become a physician who could prevent such needless suffering.”
The vast majority of diabetes cases are Type 2, where the major risk factor is being overweight and is now, according to Izuora, “becoming even more prevalent even among children. Several studies have correlated the rate of increase in obesity prevalence with the increasing prevalence of Type 2 diabetes. Tackling obesity will have a direct effect on reducing diabetes incidence and prevalence and associated complications like amputations.”
There are two types of diabetes: Type 1, an autoimmune disorder, and Type 2, a metabolic disorder. According to the CDC, about 90-95 percent of diabetes cases are Type 2. Both types are chronic diseases that affect the way the body regulates blood sugar or glucose. Glucose is the fuel that feeds the body's cells, but to enter cells it needs a key. Insulin is the key. People with Type 1 diabetes don't produce insulin and need to take insulin shots, or wear an insulin pump every day. Insulin is needed to manage your blood sugar levels and give your body energy. People with Type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin, so they, too, need to add insulin or another injectable medication because their blood sugar levels are not well managed with oral medication. Both types can lead to chronically high blood sugar levels, increasing the risk of diabetic complications, which include cardiovascular disease, nerve and kidney damage, and, during the recent coronavirus epidemic, an increased risk of COVID-19 complications.
A healthy diet – one with plenty of fruits and vegetables and largely devoid of processed foods that lead to eating more than the recommended amounts of sugar, salt, and fat – combined with regular physical activity, maintaining a normal body weight and avoiding tobacco use, are ways to prevent or delay the onset of Type 2 diabetes.
With the proper diet, physical activity, medication, and regular screening and treatment, diabetes can be treated and its consequences avoided or delayed.
“Unfortunately,” says Fatima, “eating healthy is not an option for many people, because it costs more than unhealthy food. This affects their dietary choices and health outcomes. We need policy changes that can address these issues.”
She says one positive step in policy was the 2022 passage of the Inflation Reduction Act by Congress that capped insulin prices at $35 per month for Medicare beneficiaries. “This was a huge relief for many of our patients. However, there is still a lot of work to be done by the policy makers to solve the medication coverage problems and high copays. Patients with diabetes also require high treatment costs due to the complications of diabetes such as heart and eye disease, making it one of the more expensive chronic medical conditions.”
Too often, Fatima says, patients with a lack of resources, which can involve transportation, don’t see a physician when experiencing symptoms of diabetes that can include frequent urination, unquenchable thirst, insatiable hunger, blurry vision, numb or tingling hands or feet, exhaustion, losing weight without trying, and very dry skin. Even with resources, people sometimes ignore symptoms and a trip to the doctor. Singer Patti LaBelle only learned she had the disorder after she collapsed on stage, a misfortune that she says saved her life by alerting her to the need for treatment.
What cannot be ignored in the treatment of diabetes, according to Fatima, is the role that personal responsibility plays. She says she sees patients who exacerbate their conditions by not following prescribed medical treatments, pointing out there are those with the disease who won’t give up soda or alcohol and their favorite junk foods and suffer the consequences.
Izuora, who immigrated to the U.S. from Nigeria, specialized in endocrinology because of his fascination with the endocrine system, an intricate network of glands that produce hormones that regulate various functions in the body. “In disease,” he points out, “when the hormones are too high or too little, those functions they regulate become abnormal. Diabetes, for example, is from too little effective insulin and hyperthyroidism is from too much thyroid hormone.”
At present, Izuora, the program director for the endocrinology fellowship, says there are about 50 practicing endocrinologists in Nevada. “For the population we have in our state, this is grossly inadequate. The shortage of endocrinologists results in long wait times to receive necessary care and poorer outcomes for our population. Fortunately, diabetes is one condition that our primary care physician colleagues help to manage, especially when it's not too complicated.”
There is a critical need, Izuora says, for more funding for diabetes-related research and to improve access to new expensive medication and technology necessary for managing diabetes. ”Through our fellowship (four endocrinology specialists have graduated since the fellowship was established), we hope to train and attract physicians that will contribute to developing the infrastructure for diabetes-related research in our state.” The ADA reported that in 2023 the National Institutes of Health did not invest money in diabetes-related research in Nevada.
Research does produce results. New developments in diabetes treatment, says Izuora, do offer more hope to individuals with the disease.
“There are several new developments in technology and medications used to treat diabetes. We now have insulin delivery devices that communicate with glucose sensors to provide automated insulin delivery. This is particularly useful for patients with Type 1 diabetes who are insulin dependent. There is now medication that can delay the onset of Type 1 diabetes when risk is identified and treatment is started early. There are newer and safer medications that result in significant weight loss and reduced rate of diabetes-related complications like heart disease, stroke and kidney diseases. These advances have the potential to prolong and improve the quality of life of our patients with diabetes.”
