HEALTH MATTERS Diabetes is public health enemy No. 1 for 1889 Jefferson Center

Tribune-Democrat - 1/7/2018

Jan. 07--The 1889 Jefferson Center for Population Health in Johnstown is a partnership between the 1889 Foundation and the Jefferson College of Population Health of Thomas Jefferson University. The center will identify, quantify and develop strategies for improving the health of the citizens of Cambria and Somerset counties. To do that, the center is actively helping existing community organizations that are improving health and is planning events for our community to learn how to manage their health and improve their quality of life. The center will also be exploring ways to help our residents get preventative care, especially for children.

David Bassaro knows how important it is to manage his Type 2 diabetes.

The 65-year-old Nanty Glo man walks at least a mile and a half every day, watches his diet and checks his blood sugar daily.

"I feel great," Bassaro said. "Everybody says I'm doing good. I don't want to wake up some day and my kidneys stop working."

Bassaro is among more than 1 million Pennsylvanians who have been diagnosed with diabetes. An estimated 3.5 million more are at risk of developing the disease.

The 1889 Jefferson Center for Population Health in Johnstown has identified diabetes as the region's No. 1 public health priority.

Cambria County has the sixth-highest rate of diabetes in Pennsylvania, which is among states with elevated rates for the disease.

"Diabetes is a pressing issue in this region and in the United States," Marquita Decker-Palmer, associate executive director, said at the Center for Population Health's office in the Crown American building.

"For every five dollars spent on health care in the country, one dollar is spent on diabetes care."

'A metabolic disease'

The center is spending the first year of its programming focused on diabetes. A partnership of Johnstown's 1889 Foundation and the Jefferson College of Population Health of Thomas Jefferson University in Philadelphia, the center is pulling existing programs together and exploring new research-tested approaches to diabetes prevention and management.

What to know

Symptoms of diabetes:

--Urinating often

--Feeling very thirsty

--Feeling very hungry -- even though you are eating

--Extreme fatigue

--Blurry vision

--Cuts/bruises that are slow to heal

--Weight loss -- even though you are eating more (Type 1)

--Tingling, pain or numbness in the hands/feet (Type 2)

Risk factors:

--Prediabetes diagnosis

--Overweight

--Age 45 or older

--Parent, brother or sister with Type 2 diabetes

--Physically active less than three times a week

--Women who had gestational diabetes or who have given birth to a baby who weighed more than nine pounds

--Rates are higher for African-American, Hispanic/Latino American, American Indian or Alaska Native

The Conemaugh Diabetes Institute, headquartered in Conemaugh Memorial Medical Center's Lee Campus, is a key partner in the center's initiative.

That's where Bassaro learned to control his disease through the year-long diabetes self-management education program, certified by the American Diabetes Association. He continues to participate in the institute's support group.

"Our mission is to make our communities healthier," manager Barbara Duryea said at the institute. "We provide patient-centered care using a team approach, because there are so may areas of your life that diabetes impacts."

Simply put, diabetes causes blood glucose, or sugar, levels to rise higher than normal. Left uncontrolled, it can lead to heart disease, kidney disease, vision problems and vascular disease in the extremities.

"Diabetes is a metabolic disease," Dr. Taher Elsdai, endocrinologist, said at his office in Conemaugh Medical Park. "The body cannot make enough insulin. With the help of insulin, the body can metabolize glucose.

"Insulin is produced in the pancreas. When there is a problem in the pancreas, it is no longer able to produce insulin. That is diabetes."

'Make A Choice'

There are two main types of diabetes. The Centers for Disease Control and Prevention says Type 1, formerly called juvenile diabetes, is caused by an autoimmune reaction in which the body's immune system attacks cells in the pancreas that make insulin, eventually cutting off insulin production.

About 5 percent of people with diabetes have Type 1.

With Type 2, the body develops insulin resistance, in which cells don't respond normally to insulin. The pancreas responds by making more insulin, but that causes it to wear itself out.

"Your pancreas can no longer meet the body's requirements to burn glucose," Elsdai said.

Obesity is a major factor in Type 2 diabetes because the body simply has more mass for the insulin to treat, Elsdai said.

"The insulin is no longer working sufficiently, and you need more insulin in order to meet the metabolic requirements of the body," he said.

"Your pancreas is exhausted early because it has to produce more and more insulin to meet the needs."

The good news is that an estimated 90 percent of Type 2 diabetes is preventable through lifestyle changes. Conemaugh Health System joined the Department of Health and Philadelphia-based Health Promotion Council in the Make A Choice initiative designed to promote healthy living, physical activity and weight management. The campaign website, makeachoice.org, offers a variety of resources, including a diabetes risk assessment test.

The test indicates those who may have a condition called prediabetes, in which blood glucose levels are elevated, but not high enough to be diabetes. Studies show those with prediabetes are at significant risk to develop diabetes, but it experts say prediabetes is reversible.

"I encourage people to go to the (Make A Choice) website," said Christina Miller, Health Promotion Council executive director. "Take the diabetes screening test. It will tell people if a conversation with their health care professional is warranted."

'Not just a quick fix'

If further testing verifies prediabetes, the website offers connections to local programs, including the diabetes prevention classes at Conemaugh Diabetes Institute. The multidisciplinary program covers diet, exercise, medical and behavioral health aspects of healthy lifestyle change.

Major complications

Here are some significant potential complications associated with diabetes:

--Neuropathy -- can cause numbness in the feet as well as other complications.

--Diabetic ketoacidosis -- condition that can lead to diabetic coma or death.

--Kidney disease

--High blood pressure -- raises risk for heart attack, stroke, eye problems and kidney disease.

--Stroke

--Hyperosmolar hyperglycemic nonketotic syndrome -- serious complication caused by extremely high blood sugar.

--Gastroparesis -- affects the normal spontaneous movement of stomach muscles, preventing stomach from emptying properly.

Classes meet every week for six months and then monthly for another six months.

There are group and individual sessions, with additional support services available. The institutes has satellites at Conemaugh Miners, Conemaugh Meyersdale and Conemaugh Nason medical centers.

"We will go through a lot of different topics," Ashley Staruch, a registered dietitian, said at the Lee campus. "It is about nutrition, which is healthy eating, not just a quick fix.

"Most people are looking for a quick fix. Quick fixes don't work. We look at all lifestyle choices."

Participants are encouraged to become more active, moving toward a goal of 150 minutes of vigorous activity each week.

"It's baby steps to get there," Staruch said. "That's part of the reason the program is a year long."

Bassaro appreciates the institute's support. With the help the institute staff and his wife, Michelle, he believes he has his diabetes under control.

He admits he wishes the services had been available a decade earlier.

'Take it day by day'

The Johnstown program was launched in 2006, just four years after the American Diabetes Association first defined prediabetes as a separate condition and defined guidelines for healthy body mass and exercise.

But Bassaro had already been diagnosed with diabetes, after unsuccessfully trying to find support for his own prevention efforts.

Bassaro first realized he might be at increased risk for diabetes when his mother died from diabetes-related heart disease.

He knew diabetes was often passed on through families, so he wanted to explore prevention options.

"I asked doctors to put me on a diet and tell me about an exercise plan to see if I could not get diabetes or have the disease delayed," Bassaro said.

"They said there is nothing we could do."

Although his doctor told him he's the only diabetes patient who has followed all the recommended lifestyle changes, Bassaro still struggles.

"It's frustrating," he said. "You take it day by day. I am sort of waiting for the other shoe to fall."

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.

___

Visit The Tribune-Democrat (Johnstown, Pa.) at www.tribune-democrat.com

Distributed by Tribune Content Agency, LLC.