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James Gavin, M.D.: Diabetes—‘It’s an Emergency’

This is the epidemic of our time

“Diabetes is truly the epidemic of our time,” says James Gavin, M.D., chief executive officer and medical officer of Healing Our Village, an Atlanta-based advocacy company. “Ebola’s important. HIV/AIDS is important. But diabetes is the epidemic of our time. No organ is spared with diabetes.”

A passionate advocate for community-based interventions, Dr. Gavin, a past president of the American Diabetes Association, spends his days training and educating health-care professionals and minority communities. Recently, he shared his concerns about the growing diabetes epidemic with Black Health Matters.

BHM: What are some of the most alarming statistics about this disease?

Dr. Gavin: One person dies every 10 seconds from the ravages of diabetes. With diabetes, strokes, heart attacks are more common. It is a major chronic disease that drives our trillion dollar health-care budget.

BHM: As with many chronic disease, diabetes affects African Americans in higher numbers. Talk to us about this.

Dr. Gavin: Diabetes favors minorities. It simply likes to be in us. This is important because when you look at the outcomes, amputations are more common in African Americans. This is a dreadful complication; less of you comes out than when you go in. We suffer more end-stage renal failure. Coronary heart disease is the leading cause of death in diabetes, and premature death from coronary heart disease is greater in African Americans than in whites, Hispanics and Asians.

BHM: Why does it seem like we’re seeing a spike in diabetes cases?

Dr. Gavin: The companion epidemics are diabetes and obesity. Body mass and weight gain are the leading contributors to the formation of diabetes. The higher your body weight, the more likely you’ll develop diabetes. Approximately 111 million U.S. adults are overweight or obese and have weight-related comorbidity.

BHM: What does this mean?

Dr. Gavin: You can be overweight and fine, but the minute you develop a comorbidity, you have problems. Eighty-eight percent [of overweight or obese people] have at least one weight-related disease, such as high blood pressure, diabetes or high cholesterol.

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BHM: How can current obesity trends in this country be changed?

Dr. Gavin: We don’t eat like this because somebody makes us. We eat like this because we like it. My father used to say, “The only way to really stay out of trouble is to avoid it.” You can’t change the disease once you have it. You can’t change your age, your gender or your genetics. But you can change high cholesterol, high blood pressure, smoking, poor glucose control, obesity, physical inactivity and poor eating habits.

BHM: It seems diabetes news has been alarming for a while.

Dr. Gavin: And now the crisis has reached children. Fifty-eight percent of overweight children have one or more risk factors for diabetes. Type 2 diabetes, high blood pressure, heart disease, joint deterioration—these used to be adult diseases. Now they are being diagnosed regularly in children due to trends. Children of color have more obesity and overweight. That’s something about which we must be concerned.

BHM: Can we tell which children will become obese in young adulthood?

Dr. Gavin: The highest odds of you being an obese adult is if you have two obese parents. If you were obese as a child and stay obese into your teens, the likelihood is overwhelming you’ll be an obese adult with health issues.

BHM: How do we counteract these disturbing trends? What can we do better?

Dr. Gavin: There has to be a national effort, with respect to the obesity part of the diabetes epidemic. There has to be public awareness, advocacy and education. But there’s no point in recommending fresh fruits and vegetables if people live in food deserts and can’t buy them.

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We have to have healthier meals for schoolchildren, with skim milk and water as the default beverages. We need healthier hospitals, food for patients and staff, and hospital visitors. We have to encourage more physical activity and highlight strategies and solutions to childhood obesity.

We don’t talk about prediabetes as much as we should. It’s not classified as a disease and there’s no reimbursement for seeing people in that stage. When we know that risk is on a trajectory to a bad place, that’s when we need to inform patients that this is not where you want to go, but this is a certain destination given the trajectory you’re on. We have to reshape the narrative and do a better job.

BHM: Is anybody doing these interventions successfully?

Dr. Gavin: We have some of this with Let’s Move!, the President’s Council on Physical Fitness and Partnership for a Healthier America. Community-based African-American churches in Atlanta successfully implemented diabetes prevention programs and diabetes self-management programs. Forty-eight percent of the people who participated lost at least five percent of their body weight. That’s impressive for a self-driven program.

BHM: Is there any good news on the diabetes front?

Dr. Gavin: The good news is that we have drugs that can be used effectively at any stage of this disease. Some reduce blood sugar while also reducing weight and blood pressure. Some may have protective effects against heart damage. But you have to have a frank discussion with your health-care provider about side effects. And no drug works unless they are taken as required.

Sometimes we’re not aware that new drugs, devices and therapies out there because we don’t participate in clinical trials. We need to increase community awareness of disease state and clinical research.

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