Rewinding type 2 diabetes
In Bermuda, doctors and patients are looking at the Diabetes Rewind Programme as the way forward. Offered free to people insured with Argus through a partnership between Island Health Services and the Bermuda Diabetes Association, medical professionals saw it as a way to address the local rise of type 2 diabetes which they say is “markedly higher than in comparable countries”. Of great concern was that children in their early teens were identified as having the chronic disease. According to endocrinologist Andrew Jamieson, Diabetes Rewind has seen tremendous success: 29 patients in its in-person programme had an average weight loss of 10lbs; 11 patients in its online programme lost an average of 38lbs over three months and an average of 35.9lbs over six months.
Q: What is the Diabetes Rewind Programme?
A: We are offering two very different approaches – in-person and online – to help create long-term sustainable diet and behavioural change, reduce medications and improve overall health for type 2 diabetes patients. We have partnered with the Bermuda Diabetes Association to provide an in-person programme for individuals who want to have either small groups or larger group settings with a Bermudian dietitian face-to-face, or there's an online programme, with UK-based Oviva, which people can use through an app. They'll get the same support benefit from the online coach through the app, through telephone messages etc. It’s a comprehensive, initially three-month programme, that explains what type 2 diabetes is, how it occurs and what you can do to make changes. It supports people all the way through those stages, giving them feedback but also monitoring.
Q: How does the monitoring work?
A: You get a glucose monitor on your arm that allows you to constantly be aware of your blood sugar so that you can see just how much a coffee roll will make your blood sugar go up and how much your broccoli doesn't. It’s there to try and encourage people to see how the changes that they make impact positively on their blood sugars.
Q: What is the incidence of type 2 diabetes here?
A: We don't have accurate figures in Bermuda. The last data that we had is probably almost a decade old but certainly in speaking to colleagues, the sense that there is an increase in the prevalence of diabetes is certainly there.
Q: Is there a demographic more impacted than others?
A: We've seen a significant increase in cases of diabetes, particularly type 2 diabetes, in children, particularly young women between 14 and 18. There was a recent publication that suggests that in the United States almost 50 per cent of adults in the Caribbean/African-American population are overweight or obese and that tracks through the incidence of type 2 diabetes as well. Lifestyle plays a massive part in causing individuals to develop diabetes, particularly if they have a genetic predisposition.
Q: If genetics is not on your side, what can you do?
A: That's where the importance of lifestyle management [comes in]. You cannot change your genetics but the things you can change are the lifestyle elements that may well precipitate the development of diabetes later on in life, or earlier on in life. When I started in diabetes 30-odd years ago, type 2 diabetes was people in their forties, fifties, sixties and seventies. The idea of a teenager with type 2 diabetes was almost unimaginable but there’s a lot of doctors who see patients just like that.
Q: To what do you attribute the rise?
A: There’s a whole number of factors that are definitely involved – drinking sodas, eating [fried food], fast food. Maybe five years ago in Bermuda there wasn't an easily available delivery service. You had to go out and get your fast food, which made it slightly less attractive. And of course, the cost of living is rising everywhere, [there is rising] inflation everywhere and there’s the cost of vegetables and cooking your own meals – these are things that clearly impact upon individuals who may not have the time, the skills or the inclination to prepare regularly through the week. It's much easier to pick up the phone. I think the convenience has taken away from the benefits that were taken for granted previously – the benefit of going to the shop and walking home with your shopping basket.
Q: What can we do to counteract?
A: The Diabetes Rewind Programme. My hope is that a 200lb person, for example, would lose between 10 per cent and 15 per cent of their body weight in a year and would not be on medication and would be in a state of remission in terms of diabetes. By doing so, that person saves the cost of the medications, the potential side effects from medications, their blood pressure will be better, cholesterol will be better. They’ll be physically feeling better.
Q: Is the programme open to people of all ages? To children?
A: At present this is for adults with Type 2 diabetes because that's where the majority of the problem is.
Q: And as far as medication, what's on offer?
A: In the last few years, particularly during the pandemic, there was an explosion in the popularity of injectable medicines. The one that everyone probably has heard of is Ozempic, which has been around for about six years now. It is primarily a drug for the treatment of type 2 diabetes and people who are overweight; they benefit from it greatly. It has been recast to become a weight loss drug and the manufacturers have done very well with that and are making millions in doing so. The problem with those drugs is that as soon as you stop using it, within a year, 75 per cent of people have put the weight back on. So you have to accept it as a long-term option [which comes at], financial cost and side-effects. About 10 per cent of people will stop using it because of side-effects such as nausea or constipation and there is an increased possibility of getting gallstones, inflammation of the pancreas gland, constipation …. For individuals who have tried [other] medication or tried the Diabetes Rewind Programme and have been only partially successful, then medications such as Ozempic can be useful.
Q: What got you interested in endocrinology?
A: It's one of those specialities which often attract people who like knowledge, like dealing with people. It's one of the few specialities where you can spend most of your time in direct contact with your patient rather than just looking at tests and doing operations. You kind of have to speak to your patients because of the personal aspects of it.
Q: How many people are likely walking around with diabetes not knowing that they have it?
A: For everyone who knows that they have diabetes there’s the potential that there is another person who has diabetes but is unaware of it. So, there may be anywhere between 6,000 and 8,000 people affected in Bermuda [if you think, there’s 5,000 people potentially].
Q: And they don’t feel sick?
A: Many people with type 2 diabetes will very slowly accumulate symptoms that they will not necessarily think of as being out of the ordinary because they have been so slow in how they have affected them. The classic symptoms of weight loss, going to the bathroom a lot, getting up at night to go to the bathroom and drinking water through the night, affects only a very small proportion. People who have problems with snoring, for instance, sleep apnoea, are at greater risk of having diabetes; people who get pain in their feet, a burning sensation because of neuropathy, should get checked.
That’s the challenging thing about diabetes. It is diagnosed by a blood test but the manifestations of it can affect anything from your scalp to the soles of your feet. I always encourage people to be proactive, especially if you know someone in your family has been told that they have diabetes, then get yourself checked and keep getting yourself checked at regular intervals.
As part of Diabetes Awareness Month, Island Health Services will hold a virtual lunch-n-learn on November 23 hosted by the Bermuda Diabetes Association. Dr Jamieson will host a second virtual talk on November 28.
• For more information, visit www.thebetterhealthpartnership.com/programmes/, firstname.lastname@example.org or call 298-0444