Geographic Disparities in T2DM and CVD Prevention

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A call to action for more focus on the management of the type 2 diabetes epidemic around the globe.

Davida Kruger, NP: Welcome to the HCPLive® Peers & Perspectives presentation titled “Treating Type 2 Diabetes: Looking Ahead.” I’m Davida Kruger, certified nurse practitioner in diabetes at the Henry Ford Health System in Detroit, Michigan. Joining me today is Margo Minissian, executive director Geri and Richard Brawerman Nursing Institute at Cedars-Sinai Medical Center in Los Angeles. Welcome, Margo, let’s begin. I’m excited about the discussion with you today.

Margo B. Minissian, PhD, ACNP: I am as well very excited to be with you today and thank you so much for the invitation.

Davida Kruger, NP: We are going to focus on type 2 diabetes [T2DM], and while type 1 diabetes is very important and dear to my heart, the number of people with type 2 diabetes and the expanding number and the risks and what we don’t have available, when I look across the country and I think of the lack of endocrinologists and that’s where people like myself and you, other nurse practitioners [NP], physicians assistants, are picking up the slack and also the majority of care is being taken care of by the primary care world. The knowledge we have as specialists, it’s important to push it out there so that everybody is on the same playing field. But let’s talk a little bit about some of the racial and geographic disparities, and the prevalence of what is going on with type 2 diabetes, would you like to speak about that?

Margo B. Minissian, PhD, ACNP: I would and I want to remind everyone, we are speaking of a global epidemic here, not only are we dealing with COVID-19 as a global pandemic, diabetes and its impact on cardiovascular mortality is just as vitally, if not more impactful worldwide, especially for those countries that expand from Europe to Asia. Our Latin American countries are struggling with rampant amounts of diabetes that is progressing over time that we’ve seen even significant increases since 2015.

Davida Kruger, NP: When I think of that, I’ve been in diabetes now for 40 years. I can’t believe this is marking my 40th year and when I first started, we didn’t have the knowledge we have now. First of all, we didn’t think it was a very serious disease, we thought it was OK to leave people. When I started there were only about 8 million people in the United States with type 2 diabetes and what is it, 40 million now? It is huge, and that’s just in the United States. There is a huge link for those with diabetes and cardiovascular disease and that’s become more apparent that diabetes is not a disease of just glucose, it’s a cardiovascular disease and what we want to do is prevent cardiovascular disease and I know that’s your research and all the things you’ll get to share with us today but I think that the listeners need to understand that if we can, just by having diabetes, just diabetes alone, women lose about 7.8 years of their life, men about 7.2 and if women don’t have diabetes they don’t have to worry about cardiovascular disease until post-menopause, that’s not true if you have diabetes. Now that’s without cardiovascular disease. If someone has an MI [myocardial infarction], you’re now decreasing their lifespan by about 18 years. If they have a stroke, about 15 years, and if they have a stroke and an MI and diabetes, another about 20 years, which to me is horrible. What are we going to do? We must do prevention. What are your thoughts on that?

Margo B. Minissian, PhD, ACNP: What you’re touching on is very close to my heart. I have a personal history of having a father who was a type 1 diabetic, and you know, as a little girl, you know remember him going through multiple amputations and having several heart attacks and strokes and he was a big tough guy. He was a Green Beret in the army. He didn’t even realize that he was a type 1 diabetic until he got through training, shockingly. But watching him deteriorate in front of my eyes as a child is probably the reason why I’m a cardiovascular prevention scientist today and what I’ve learned from that is it’s all about these fluctuations in blood sugar that can be so detrimental and our blood vessels are just swimming in glucose, for example, and it affects our brains, it affects our hearts, it affects every aspect of every organ in our system. The good news is that we can get ahead of this with cardiovascular prevention, thank you for allowing me the opportunity to speak to that today.

Davida Kruger, NP: I want to thank our audience for watching HCPLive® Peers and Perspectives. If you enjoyed the content, please subscribe for our new e-newsletter to receive upcoming Peers and Perspectives and other great content right in your inbox. I receive it and I really love it when I see it in there. Take some time to enjoy it. Thank you again for joining us.

Transcript edited for clarity.