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HOUSE CALL WITH DR. SANJAY GUPTA

Diabetes Epidemic Continues To Worsen; Body Shape Is Risk Factor; The Role Of Diet And Exercise To Control Diabetes; Type 2 Diabetes On The Rise In Kids

Aired November 12, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

TONY HARRIS, CNN ANCHOR: Stories "Now in the News".
U.N. Secretary-General Kofi Annan is in Baghdad today meeting with political and community leaders. He's there to urge all Iraqi factions to take part in shaping their country's future. The Baghdad visit comes a day after Annan toured two of the three hotels bombed in Jordan this week.

Just a few hours ago, the Jordanian government confirmed that al Qaeda in Iraq is responsible for the suicide bombings this week in Amman, Jordan. A highly-placed Jordanian source tells CNN that the three bombers were Iraqi and that they entered the country three days before the attacks. Jordanian officials say it appears the bombers were all men. That counters an al Qaeda claim that a husband and wife took part in the attacks.

Dr. Sanjay Gupta takes a closer look at efforts to control the growing diabetes epidemic. HOUSE CALL begins right now.

DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning, welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.

Well, the last time we talked about diabetes, the government had declared it an epidemic. Unfortunately, this epidemic has only worsened, with 21 million Americans living with the disease. Now that's an increase of 14 percent in just two years.

And as Christy Feig explains, diabetes is a serious condition that requires vigilance.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Olivia McKenzie has been battling diabetes for more than a decade. And although she still has days like this one, when her blood sugar is too high, she's made many changes to how she eats.

OLIVIA MCKENZIE, DIABETIC: I like cake and I like candy, but it's not hard to not eat that.

FEIG: Her struggles are quite common, according to the American Association of Clinical Endocrinologists. The group looked at nearly 160,000 diabetics across the country to see how well they were managing their blood sugar levels. They found 70 percent of the patients in the study routinely had high blood sugar levels. And that raises the risk of serious medical complications.

JAIME DAVIDSON, UNIV. OF TEXAS SOUTHWESTERN: People will be blind. People are going to be on dialysis. People are going to have amputations. And the cost of that is a lot more than treating diabetes well.

FEIG: The other experts aren't surprised by the findings. They say people with diabetes don't always have healthy habits to begin with. And it's a difficult disease for many patients to manage.

DR. STEPHEN CLEMENT, GEORGETOWN UNIV. HOSPITAL: They have lots of weight issues they struggle with. Some of the medications, they have side effects. So they have difficulty in taking medications.

FEIG: Nonetheless, studies show if it is not managed well, diabetes can shave up to 15 years off your life.

In Washington, I'm Christy Feig.

(END VIDEOTAPE)

GUPTA: All right, Christy, thanks. We are focusing on Type 2 diabetes this morning. It accounts for about 90 to 95 percent of diabetes cases in this country. And the complications of it can be staggering, starting with a much higher risk of heart disease and stroke, not to mention blindness, kidney, and dental diseases, plus nerve damage, and amputations.

The good news in many cases, it can be prevented.

Here to tell us now is Dr. Frank Vinicor. He's the head of the Centers for Disease Control Diabetes program. Welcome. Good to see you again.

FRANK VINICOR, DIR., CDC DIABETES PROGRAM: Glad to be here.

GUPTA: The numbers are pretty staggering. And I read another number that one in three Americans born in the year 2000 could develop diabetes over their lifetime.

VINICOR: Right.

GUPTA: Why is that?

VINICOR: Well, there are basically three reasons. One is that we're discovering it, that people who have it, that it's undiagnosed who are finding it.

The other reason is that our population in general is aging, particularly communities who are already at risk, so African-American, Native American communities.

But the third factor is our weight and our physical inactivity. And as you know, Sanjay, the country is getting heavier. We're not getting more active. And the combination of those factors accounts for this epidemic. GUPTA: And in kids in particular as well.

VINICOR: In kids, what we've recently observed at the CDC is that while we don't see a lot of kids with what used to be called adult diabetes, we see a stage right before that, so-called pre-diabetes now being very, very common. So in five, 10 years this is really a threatening observation.

GUPTA: You know, American Indians, Latinos, and African-Americans are hit harder by diabetes, as you mentioned, which brings us to this question from Vanessa in Colorado who wants to know this. "Why is it that African-Americans have diabetes at such a higher rate?" What is it about the community?

VINICOR: Well, it's probably, as in most things, a combination of so-called nature and nurture. That is, there may be some genetic factors there. But the expression of those genetic factors is what I do as an individual. And if you look to see what the people from an African-American community, Native American community, Hispanic community are doing, they're also gaining a lot of weight. And so this weight gain is allowing those genes to express themselves.

GUPTA: It's not that simple, though, right? Just the weight gain here?

VINICOR: Well, it's weight gain and it's physical inactivity. That is probably the major factors, but it's also the factors that we can do something about.

Presumably, we're not going do anything about my aging. We're not going do anything about my parents. We're not going to do anything about the fact that I might come from a certain racial, ethnic community. You can't change that.

GUPTA: Right.

VINICOR: What can we focus on? Those factors such as my appetite, my weight, my physical inactivity.

GUPTA: Let's get going with the email questions here. Another one coming in from John from Oregon who writes this. "What are the symptoms of diabetes?" A lot of people watching today say well, how do I know? Maybe I'm diabetic.

VINICOR: Well, what happens is if your sugar gets up high, it spills over in the urine. And that draws water out. And that accounts for the three cardinal symptoms of diabetes. Excessive urination, excessive thirst because you're losing a lot of water, and also your body, even though your blood sugar's high, views itself as starved. The sugar isn't getting inside the cell. And as far as the cells are concerned, I am starved. So you tend to overeat. That with maybe blurred vision.

But I think, Sanjay, it's important to point out that there may be no symptoms or only symptoms that are sort of mildly suggestive like cuts that don't heal. GUPTA: Right. Some of those -- all of these things to sort of watch out for.

VINICOR: Exactly.

GUPTA: A lot of people focused, interested in diabetes. We are talking with Dr. Frank Vinicor.

More of your questions on diabetes coming up, when HOUSE CALL continues.

UNIDENTIFIED FEMALE: Millions of people are living with it and don't know it. Pre-diabetes. We'll explain what you need to know.

(BEGIN VIDEO CLIP)

YVONNE SANDERS-BUTLER, PRINCIPAL, BROWNSMILL ELEMENTARY: We took out everything that was obviously sugar.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: A principal bans sugar with surprising results. Find out later.

First, answer this. Is body shape a risk factor for diabetes? Find out after the break.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Before the break we asked, is body shape a risk factor for diabetes? The answer, yes. People who carry most of their weight around their waist are at greater risk of diabetes than other body types.

GUPTA: And as we've talked about carrying any kind of extra weight is a risk factor for diabetes, along with being inactive and having high blood pressure.

We're joined today by Dr. Frank Vinicor. He's head of CDC's Diabetes Program. And Doctor, millions of Americans have been told that they may have a condition called pre-diabetes.

VINICOR: Yes.

GUPTA: So what is that, exactly?

VINICOR: Well, we now know that there's a range of blood sugars that are normal and a range that's diabetes. And in between, a bit of a gray zone.

What we know is that people who are in this gray zone, who have pre-diabetes are very, very high risk for going on and developing regular Type 2 diabetes. But more importantly, we now know from good scientific studies that you can stop that progression to Type 2 diabetes. GUPTA: And obviously, we're definitely going to want to talk about that. Many people with pre-diabetes go on to develop the full blown Type 2 diabetes, within two years. But can you prevent this from happening?

Dee from Maryland wants to know how. She asks this question. "My 29-year-old husband went in for his annual physical and discovered he was pre-diabetic. What can he do to bring down his glucose numbers into the safe range?"

VINICOR: Great question now. Real important question because we now know you can do something about it. The studies show that if you lose as little as maybe 5 to 7 percent of your body weight, eight to 10 pounds, if you can walk vigorously, 30 minutes, five days a week, something maybe is tough, but we all can do, you can reduce your chances of going on to develop diabetes by as much as 60 percent.

And Sanjay, it doesn't matter if you're white, or black, Hispanic, Native American, if you're overweight or you're normal weight, if you're 20 or if you're 65, it works in everybody. So we can do something about it to stop the development.

GUPTA: This is the standard advice you hear about just about anything.

VINICOR: Standard advice, but now there's hard science behind it.

GUPTA: It actually works.

VINICOR: It works. It's important. If you think about reducing this epidemic by 60 percent, that's a huge number. And it means a lot.

GUPTA: That's encouraging, Doctor. Let's go back to our inbox now. Deno from Kentucky writes this question. "I'm 52-years old and my mother is a diabetic. Should I be tested at a next physical?"

And so, Doctor, when should people get tested? And when does this typically strike somebody?

VINICOR: Well still, most people have the onset of type 2 diabetes in -- roughly around age 40. There's this old adage, over, under, over, over 40, underactive, overweight.

General recommendation, if you're around 40 to 45, you should probably be tested. It's a relatively simple blood sugar test. It's pretty accurate. It's inexpensive. If you have it in your family, if you're very overweight, if you're from a minority community, you might want to be tested a little bit earlier. If it's normal, maybe every three years after that would be a typical...

GUPTA: And we're talking about a blood test here.

VINICOR: A blood test, right.

GUPTA: OK. All right. Emails coming in specifically about treatments because people say, OK, I have it, what do I do about it? Jack in Arizona asked this question. "Could you discuss some of the new drugs and products that have been released by the FDA for Type 2 diabetes?" Are there new treatments out there?

VINICOR: A lot of new treatments. We're certainly still insisting that activity, weight loss, still the essential part. But if that doesn't work, we now have at least three or four different kinds of oral tablets. These aren't oral insulins. These are tablets that make my body more sensitive to my own insulin or cause the liver to not make as much sugar. A lot of choices among tablets.

Even among insulin now, we have different kind of insulins -- ones that last a long time, a whole day; ones that last very shortly. Take it right before I eat. And now, of course, we have different ways to deliver insulin, not necessarily only by injection.

GUPTA: You know, a lot of moms out there probably saying, you know, it involves a shot, but there is the inhaled insulin, too, isn't there?

VINICOR: There is. But even before that, the shot now is actually, believe it or not, not very painful. The needles are incredibly small. Really, I've done it. It's not a great deal of pain.

But inhaled insulin -- that is, taking it almost like an inhaler for asthma -- has now been recommended for approval by the review committee. The FDA still has to make their final decision, but it's right on the edge there. It's very close to being available. And for certain people, it'll be a major step forward.

GUPTA: We are talking with Dr. Frank Vinicor about everything related to diabetes. And also, we're going to talk about the best diets. A lot of questions coming about that. What you need to know after the break.

UNIDENTIFIED FEMALE: What should and shouldn't you be eating if you're a diabetic? We'll ask about the best diets for diabetics after the break.

And later, fresh fruits versus dried fruits. Is one better for you than the other? First, this week's medical headlines in "The Pulse."

(BEGIN VIDEOTAPE)

CAROL LIN, CNN ANCHOR (voice-over): Roche, the makers of the antiviral drug Tamiflu, announced this week that they will increase production of the drug to prepare for a possible flu pandemic. They said they will have 300 million doses by 2007.

The company also announced plans to sell the active ingredient in the drug to Vietnam and allow the country to make their own stock of Tamiflu. Forty-one of the more than 60 people who have died from avian flu were from Vietnam.

And a new study found 38 percent of young adolescents who smoke may have picked up the habit after watching movies that glorify smoking. Researchers polled over 6,500 young teens about smoking habits and movies and found a strong correlation between the two.

The report recommends reducing the amount of smoking in films or incorporating smoking into the movie rating system.

Carol Lin, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: Back with HOUSE CALL. We're talking about Type 2 diabetes with the head of the CDC's Diabetes Program, Dr. Frank Vinicor.

And Doctor, you said this a couple times. Diet and exercise play a huge role in the management of diabetes. So let's first talk about diet. Lots of questions came in on that. This one is from Brian in Florida, who writes this. "I was just diagnosed with Type 2 diabetes. Does that mean I have to stop eating sugar, period?"

VINICOR: Easy answer, no. A few quick comments about diet. If it were simple, if there were the answer, we wouldn't go to the bookstores and see hundreds of books. There's not a simple answer to that question about diet.

I think my approach is to have people start off with what would be considered a reasonable diet and then see if it works for them. It does often involve for Type 2 diabetes less food and more activity. But no, you don't have to stop eating carbohydrates or sugar. In fact, most diets now allow you to include that in what you do. There are some diets that want to limit it. Some that say you can be freer a bit with carbohydrates.

The best thing is to talk to your doc or to talk to your dietitian and find out. Maybe starting off with the American Diabetes Association diet, seeing if it works, and then modifying it with one of these other diets. That's my general recommendation.

GUPTA: Well, let's keep on topic here.

VINICOR: Right.

GUPTA: Our next email sort of talks about the same thing. It's one of the most popular questions we got. Sharon in New York wants to know, "Where can I find a good, easy to follow diet for Type 2 diabetes?" You've already been talking about this, but is there a specific diet that you'd recommend or that people should be following?

VINICOR: The diet that I recommend as a starter is the American Diabetes Association diet. It allows people to talk to professionals about what they're doing, what they want to do, but then allows adjustments.

Again, there are all sorts of variations. But you need to start somewhere. Again for Type 2 diabetes, the magic, if there is any, is this gradual weight reduction, which will be beneficial, that can be accomplished with the American Diabetes Association diet. And then if it's not working -- and it doesn't in everybody -- then you go to one of these different diets, restricting this, restricting that.

But you've got to start somewhere. And I think that's the most neutral effective place to start.

GUPTA: And if you have been diagnosed recently, it doesn't mean you necessarily need to take medications right away. I think that's become clear.

And if people are curious about the American Diabetes Association Diet, we are going to have that information as well at the end of show. We're going to go sugar-free, though, after the break.

Stay tuned.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: What you got?

UNIDENTIFIED FEMALE: Fruit.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: From banning sugar to getting everyone -- even teachers -- exercising, we looked at an experiment in healthy schooling coming up on HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: Welcome back to HOUSE CALL. While Type 2 diabetes is still unusual in children, the numbers are starting to rise. And many experts link that to increasing obesity rates.

Elizabeth Cohen discovered one principal taking aim at obesity in her classrooms.

(BEGIN VIDEOTAPE)

ELIZABETH COHEN, CNN CORRESPONDENT (voice-over): Inside this red brick school house is a sugar-free zone. When Principal Yvonne Sanders-Butler arrived at Brownsmill Elementary School eight years ago, she says she noticed a direct link between diet and academic performance.

SANDERS-BUTLER: What are we having today?

I saw kids very overweight. I saw a large percentage of kids coming into the clinic for headaches and stomach aches, even before we started class. And I would look at what they would eat in the morning or what they would not eat.

COHEN: Butler could relate. Her nickname once was sugar woman. She remembers feeling high after first tasting chocolate milk at school in rural Mississippi. Her sharecropper parents served food they grew, but her mother was also known for baking sugary treats.

As an adult, Butler packed on the pounds. At age 39, she was obese and in trouble, dangerously high blood pressure, joint pain from the weight. She almost suffered a stroke. So after 20 years of yo-yo light dieting, Butler joined Overeater's Anonymous and started to take control.

SANDERS-BUTLER: It is a lifestyle change. There is no magic bullet. There is common sense.

COHEN: A lesson she brought to Brownsmill.

SANDERS-BUTLER: We took out everything that was obviously sugar. We took out chocolate milk. We took out sugary desserts. We took out ice cream, all of those things that kids just like to gorge on.

Children were more on task, more attentive in class during class time. The other thing that we saw, our test scores increased by 10 percent.

COHEN: Children at Brownsmill now start their day with stretching.

UNIDENTIFIED MALE: Relax. Stand up tall.

COHEN: Lots of exercise, and lunches with whole wheat breads, fruits and vegetables.

Butler has a new book filled with recipes, a guide for families in the fast lane. Last spring, Brownsmill Elementary did not pass a USDA check for calcium levels. Now Butler has made the grade by adding vanilla and strawberry-flavored milk and animal crackers to the menu.

The George Department of Education says the best approach to combating obesity in elementary school is a greater emphasis on nutrition education for students and parents. Yvonne Sanders-Butler says she knows some may see her approach as radical, but she's out to change the world one child at a time.

SANDERS-BUTLER: We all have sort of like a treadmill life. And so we're just trying to maximize the moment. I know that we can do that and still be healthy.

COHEN: Elizabeth Cohen, CNN, Atlanta.

(END VIDEOTAPE)

GUPTA: Wow, Elizabeth, thanks so much. And good luck, of course, to the Brownsmill Elementary School as well.

Just ahead, could there be a cure for Type 2 diabetes? We're going to ask our guest, Dr. Frank Vinicor after the break.

(COMMERCIAL BREAK)

GUPTA: And we're back with HOUSE CALL. We've gotten a lot of questions on diet. Which foods are good to eat or bad, depending on sugar content. Well, our "Bod Squad" checks out fruit. Specifically, dry versus fresh. Now is one better than the other?

(BEGIN VIDEOTAPE)

HOLLY FIRFER, CNN CORRESPONDENT (voice-over): We love them -- strawberries, grapes, pineapples, and apples -- delicious, fresh fruits rich in Vitamin A and C, folate, potassium and fiber. But are fresh fruits any better for us than their dried counterparts?

Registered dietician Dana Nahari says they both have similar amounts of nutrients.

DANA NAHARI, REGISTERED DIETICIAN: Because of the water content that's associated with fresh produce it can fill your stomach up more. And you get less amount of calories in as for the amount of volume that you're consuming.

FIRFER: Dana has a healthy take-home message when it comes to people with diabetes. Fresh fruit or dried fruits can play an important role in satisfying the sweet tooth and combating obesity.

NAHARI: Fruits and vegetables are a very important part of weight management, which can help to also prevent the onset of diabetes now (ph) and later on in life.

FIRFER: Holly Firfer, CNN.

(END VIDEOTAPE)

GUPTA: OK, Holly, thanks.

And for more details on diets and other diabetes questions, click onto Diabetes.org. That's the American Diabetes Association. We promised you that Web site earlier. There it is. You can also call them Monday through Friday at 1-800-diabetes. Another helpful site is the National Diabetes Education Program, which you can access with the CDC's Web site at cdc.gov/diabetes.

We've been talking all hour with Dr. Frank Vinicor of the Centers for Disease Control. Doctor, let's get to one last question about this topic, an important one.

Rick in Louisiana wants to know this. "Can someone with Type 2 diabetes be cured with proper diet and medication?"

Do you hear the word cure and diabetes together, doctor?

VINICOR: We do, but I have to be honest to say it's more related to Type 1 diabetes. We know that when Type 2 diabetes first comes on, some weight loss, some activity, blood sugar will normalize.

The general experience has been, though, that the insulin producing cells sort of slowly continue to fail. And then you need tablets, oftentimes in combination, different types. And then the history is that generally you'll need to add insulin. So I have to say that the concept of a cure of Type 2 diabetes is somewhat off in the future. So we turn our attention to either prevention with pre-diabetes or care. And with care, Type 2 diabetes you don't have to lose your vision, your heart, your kidneys or your feet. It's important to care.

GUPTA: How big a deal has the pump been?

VINICOR: Pump has, for a lot of people, made a big difference. Both Type 1 and to some degree Type 2, particularly if you're lifestyle is very unpredictable and you're active and flexible, you need some opportunity to be flexible in how you use insulin. It's helped a lot of people.

GUPTA: All right, thank you so much. Unfortunately, we're out of time for today. I want to thank our guest, Dr. Frank Vinicor.

VINICOR: Thanks, Sanjay.

GUPTA: We really enjoyed it. Lots of good information. Make sure to tune in next weekend as well when we're going to be bringing you the latest news in heart treatments. Remember, this is the place for the answers to all of medical questions. Thanks for watching.

I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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