Wrestling the Diabetes Demon
As more Americans slide toward obesity, researchers and physicians work together to give people the power to control their own health.
There is a cadre of researchers and physicians across the Keck School of Medicine of USC that not only investigates the complicated scientific aspects of diabetes, but takes its knowledge and expertise to families and communities through educational programs and outreach.
The scientific basis for their work is profound. Within the
Keck School is renowned diabetes researcher Richard N. Bergman, Ph.D., the
Keck Chair in Medicine and chair of the Department of Physiology and Biophysics,
who 
created
the widely used “minimal model,” a metabolic test that measures
defects in insulin functions in humans that, in time, cause diabetes.
His colleagues include Thomas A. Buchanan, M.D., professor of medicine, obstetrics and gynecology and physiology and biophysics, whose research into the very beginnings of diabetes is showing that the disease can be delayed or prevented. Michael I. Goran, Ph.D., professor of preventive medicine and physiology and biophysics, seeks to find out what predisposes certain children to obesity and diabetes. Robert Chow, Ph.D., associate professor of physiology and biophysics, studies the cellular defects behind diabetes. And Richard Watanabe, Ph.D., assistant professor of preventive medicine, is scouring the genome for specific genetic tweaks that underpin the disease.
But the investigations do not stop there. Keck School faculty members want to turn breakthroughs in the laboratory into benefits for patients. Whether in homes, schools, churches or clinics, these scientists go the distance to get better health care to people with diabetes. These are just a few of the many Keck School physicians who are making a difference in diabetes.
Joyce Richey
“My father has diabetes and I’ve had two brothers in the past three years who were diagnosed with type 2 diabetes,” says Joyce Richey, Ph.D., assistant professor of research in the Department of Biophysics and Physiology at the Keck School of Medicine. When Richey was a child, her cousin had type 1 diabetes, though for a long time she was unsure why he was ill. “I knew he had ‘sugar’—that’s how we often refer to it—but I didn’t know what it was,” she says.
At that time, physicians knew little about how to control or manage diabetes, whether it was type 1 or type 2. In type 1 diabetes, the immune system destroys the body’s insulin-
producing cells, called beta cells, and sufferers must eventually use insulin; in type 2 diabetes, the body becomes resistant to the insulin made by beta cells, so glucose (a type of sugar) gradually builds up in the blood.
The mysteries surrounding diabetes made their mark on Richey, who pursued a career in the science behind the disease. At the Keck School, she looks not only at insulin resistance and its role as a precursor to type 2 diabetes, but also at its links to cardiovascular disease and high blood pressure, which tend to develop alongside diabetes. “We want to know: Is there some common mechanism at work?” she asks.
Together with colleagues at the USC Diabetes Research Center, Richey examines the relationship between obesity and diabetes. Put simply, these researchers are trying to understand if fat cells—in particular abdominal fat cells—may send chemical signals that trigger insulin resistance and diabetes.
The research is complex, but understanding diabetes does not need to be. That is why Richey teaches fellow Los Angeles residents about diabetes management and prevention. As president of the Los Angeles Leadership Council of the American Diabetes Association and chair of its African American Task Force, Richey helped spearhead programs such as Project Power, which gives people “the power over diabetes,” she explains.
Project Power is a five-part, faith-based program that works with local African-American churches to teach about the disease. After all, about 2.7 million African Americans, age 20 or older have diabetes; and a third of them do not even know it.
Instructors employ words from scripture to discuss fitness and diet—and even bring out the skillets to show how to cook healthy recipes. As part of Project Power, Richey teaches Diabetes 101, a workshop explaining some of the numbers behind diabetes, such as hemoglobin a1c levels, and why they matter to blood-sugar control. She also has delivered talks to Girl Scout troops and schools.
The outreach has not gone unnoticed, earning Richey commendations from United States Sen. Barbara Boxer and the Los Angeles City Council for her passionate efforts.
Richey has seen the difference that education can make, as evidenced by her own family members. After her brother was diagnosed, she sent him a diabetes starter kit: information on adopting a better diet, weight management, exercise and blood-sugar control, along with a pedometer and a diabetes-friendly soul food cookbook.
“I stressed to him that if you do these things, your condition will improve,” she recalls. Three months later, she says, “His wife e-mailed me to say he had lost 15 to 20 pounds and no longer needed medication.
“So you see, you have control over diabetes, at least to a degree.”
Anne Peters
Modern medicine offers advantages never before seen, from vaccines against viruses to early detection of cancer. Yet children born after 2000 are actually expected to live shorter lives than their older siblings.
Blame it on increasing levels of obesity and inactivity and their consequences: diabetes and cardiovascular disease, says Anne Peters, M.D., professor of medicine at the Keck School. Peters directs the USC Clinical Diabetes Program and sees patients at the USC Westside Center for Diabetes, as well as the Edward Roybal Comprehensive Health Center.
But Peters does not just bemoan today’s sedentary way of life. She wants to give Americans a shove, getting them off the couch and ready to take control of their own health.
An outspoken advocate for those with diabetes, Peters believes that diabetes should not stop anyone from reaching for their goals; those with diabetes just need to get the information and attention to manage their disease. One example of her philosophy is swimmer Gary Hall Jr. When he was diagnosed with type 1 diabetes and told he could not compete in the 2000 Summer Olympics, Peters helped him develop a plan against the disease. Hall successfully competed, garnering numerous medals.
To spread her convictions, Peters recently released a how-to book for those living with diabetes and those who want to avoid it. In the best-seller “Conquering Diabetes: A Cutting-Edge, Comprehensive Program for Prevention and Treatment,” Peters lays out steps readers can take to determine their own diabetes risk.
Diabetes doesn’t just happen suddenly, Peters explains. It starts with insulin resistance and pre-diabetes—a condition of higher-than-normal glucose levels in the blood that do not qualify as diabetes.
Peters urges people to get their blood sugar checked regularly. “Go to the doctor, have your blood tested after not eating overnight. See what your blood sugar is,” she said on the CNN talk show “Larry King Live.” “If it’s less than 100, you’re probably OK. If it’s more than 100, you either have pre-diabetes or, if it’s higher than 126, you have diabetes.
“Ask for your numbers. Don’t be passive.”
In some cases, Peters notes, diabetes can be prevented. If diagnosed early, its progress can be slowed dramatically, and it can be treated so that potential complications—heart disease, stroke, blindness, nerve damage and kidney failure—can be reduced or even avoided altogether.
Peters also advocates for research and policy change on a broad level to make sure that those with diabetes get the preventive and therapeutic help they need. She co-directs the Keck Diabetes Prevention Initiative, which was started in 2004 with a $2 million grant from the W.M. Keck Foundation to identify factors that contribute to decisions about diet, physical activity and health care within the East Los Angeles and South Los Angeles communities. Through the initiative, she seeks to develop prevention strategies and promote a healthy lifestyle—in ways that are effective and relevant to local residents.
In addition, she is co-chair of the Los Angeles County Department of Health Services Diabetes Committee, which is developing ways to deliver consistent care to all patients with diabetes in the county health-care system.
About 45 million Americans are at risk for diabetes, says Peters; yet few people understand that they are at risk, and many do not get the right preventive care. If she has her way, they soon will.
Marc Weigensberg
As director of pediatric endocrinology at LAC+USC Medical Center’s Women’s and Children’s Hospital, Marc Weigensberg, M.D., sees firsthand the effects of childhood obesity, especially among minorities.
Physicians used to diagnose type 2 diabetes almost exclusively among adults. But today, greater numbers of children tip the scales far above a healthy weight, and their obesity is sending childhood type 2 diabetes rates skyrocketing.
“It’s very alarming,” Weigensberg says. “If children have this disease at this age, and knowing what we know about diabetes complications, they are likely to face major mortality and morbidity at ages when they should be in the prime of life.”
Weigensberg, assistant professor of pediatrics at the Keck School, wants to do something about it. He oversees medical care in several Keck School studies exploring insulin resistance among adolescents.
Through the long-term Study of Latino Adolescents at Risk of Diabetes, or SOLAR, Keck School researchers are following obese Latino children ages 8 to 13 who have a strong family history of type 2 diabetes to see if the children develop the disease. “The goal in SOLAR is to identify which risk factors are particularly important for determining whether a child will develop diabetes,” Weigensberg says. The study is led by Goran.
“It’s important that we understand the risk factors that lead to diabetes and are able to identify them early and intervene early enough to prevent it,” he says.
He wants to give kids the tools to help themselves, too. Weigensberg is involved in the ongoing Strength Training Exercise in Adolescent Latinos to Improve Health study, which explores whether weightlifting affects insulin sensitivity in Latino boys. “In 16 weeks of exercise, not only did boys feel successful and have improved self-esteem, but they decreased their insulin resistance,” he says. “It’s not because of weight loss, but rather, we think it’s some sort of action on the muscle to increase its utilization of glucose. Or it may indirectly affect whole-body insulin resistance.”
To help kids battle obesity, Weigensberg also is testing the value of relaxation techniques.
Among adults, he explains, scientists have shown that chronic life stress may increase secretion of the hormone cortisol, which encourages packing on fat around the gut—a risk factor for insulin resistance and type 2 diabetes.
In a pilot study, Weigensberg is testing various stress reduction techniques among 14-to-16-year-olds to see if relaxation reduces cortisol during adolescence. Once a week for four weeks, he teaches relaxation through breathing, much like methods used in yoga. He also helps the teenagers relax physically, and then shows them how to visualize a journey to a place that represents comfort and relaxation.
Both before and after the sessions, the teens’s cortisol levels are tested through saliva samples. Teens are encouraged to use the techniques at home, too.
“Family, school, money and health are all potential sources of stress for adolescents,” he says. “Young adults are experiencing more stress-related symptoms today than those in the 1950s.”
Weigensberg hopes to reach out to the county’s neediest kids by developing programs through his clinic so that even adolescents who are not involved in ongoing studies can benefit from the latest scientific findings.
He says: “We want to translate findings into programs that are available to all young adults.”
Francine Kaufman
Keck School endocrinologist Francine R. Kaufman, M.D., is not just wringing her hands over the nation’s mounting problems with obesity and diabetes—she is on a mission to stop the epidemic.
Kaufman, professor of pediatrics and past president of the American Diabetes Association, has long spoken about diabetes as a public health threat, particularly among children. But now she has employed the power of the pen in her battle to raise awareness and change public policy.
In her lay-friendly book, “Diabesity: The Obesity-Diabetes Epidemic that Threatens America—and What We Must Do to Stop It,” Kaufman draws on her experiences as head of the division of endocrinology and metabolism at Childrens Hospital Los Angeles and director of its Center for Endocrinology, Diabetes and Metabolism.
By bringing people face to face with the personal stories of those with diabetes, Kaufman hopes to raise understanding about the disease, and the social and economic fabric that has made it an epidemic. Diabetes is not just about the ups and downs of blood sugar, she says; it is also about the problems faced by children who must monitor their blood sugar during school time and the challenges faced by urban children who live sedentary lives because they have nowhere to play.
Like Richey, Kaufman saw diabetes in her own family. Her grandmother Sadie was diagnosed with diabetes in 1960, when Kaufman was nine years old. A fan of cakes and sweets, Sadie resisted the diet and lifestyle changes so important to controlling diabetes—and Kaufman saw the consequences in her grandma’s worsening health. Today, she taps those memories in her passion to help others.
Despite her heavy load as a diabetes physician, educator and researcher, Kaufman also has an inventive, practical side. When she saw her patients’ blood sugar levels rush dangerously from high to low, she strove to create a way for patients to stabilize their blood sugar between meals. She found that raw cornstarch, when ingested, seemed to steadily provide patients with glucose—so she took to the kitchen to figure out how to incorporate the starch into foods. The result was the ExtendBar, a healthy snack that may combat diabetes. Her efforts earned her the moniker “Betty Crocker of Diabetes.”
She is outspoken about diabetes’ bigger picture, too. “This disease ranks number one in direct costs, consuming one health-care dollar of every seven,” Kaufman says. “In the U.S. in 2002, the tab for diabetes-related doctor visits, medications and hospitalizations was a staggering $92 billion.”
And those numbers might continue to rise if society does not change, she says.
According to Kaufman, Americans have erred by defining progress in terms of the quantity, rather than the quality, of food procured and produced. At the same time, urban sprawl encourages people to drive rather than walk and to stay on the couch rather than actively participate in their community.
Kaufman calls for changes in public policy to reverse the slide toward inactivity and poor dietary habits.
“We don’t have to be the creators of our own demise,” she says. “We can demand of our leaders, of our health-care system, of our communities and of ourselves that the world become a place in which it is possible to live not just a long life, but a healthy one—a world in which we can have normal blood sugar, normal blood pressure, normal blood fats, normal weight, healthy meals and a safe walk through the park.”
Whether through Bergman, Buchanan, Goran, Chow, Watanabe and their scientific colleagues pursuing diabetes research from cell biology to epidemiology and population genetics, or Richey’s community outreach, Peters’ one-on-one partnership with patients, Weigensberg’s efforts to empower children or Kaufman’s push for policy changes, Keck School faculty members are making their voices heard in the fight against obesity and diabetes. Now it is up to Americans to listen.
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