The Culture of Different MKTG_150064494_2018 Service Line Big Book Full_FIN | Page 62

Type 2 Diabetes
Treatment and the
Future of Healthcare
MULTIDISCIPLINARY
SPECIALTIES
FEATURED:
Diabetes and
Endocrinology
Lifestyle Medicine
Pediatric Surgery
Psychiatry
The best remedy for type 2 diabetes is theoretically simple: medication, education,
counseling and weight loss.
It starts when a teenager — let’s call him Max — is overweight or obese, and has a
diet high in excess calories and a sedentary lifestyle. Excess fat tissue causes a loss of
response to insulin and, to make up for this, the body is forced to make more insulin.
Eventually, the cells producing insulin become tired and can’t produce enough to keep
the blood sugar normal.
An endocrinologist diagnoses Max with type 2 diabetes, a condition that, even when
treated with excellent care, puts him at risk for a host of health challenges, including
hypertension, fatty liver disease, sleep apnea and a decreased life span.
Many hospitals group patients with type 1 and type 2 diabetes in the same clinic.
The immediate treatment for both is blood sugar management, but the underlying
cause of type 2 diabetes isn’t an autoimmune disease as in type 1: It’s behavior.
This should be good news, because it means people can potentially treat type 2 diabetes
with lifestyle changes. Kids like Max can improve their life expectancy and overcome
their comorbidities.
“There’s no fancy treatment for weight loss; it requires decreasing energy in and increasing
energy out,” says Megan Kelsey, MD, Director of Lifestyle Medicine Endocrinology.
But the success of behavior change — i.e., long-term weight loss — is low in everyone.
For teenagers with type 2 diabetes, it’s even lower.
“Type 2 diabetes is extremely burdensome,” says pediatric psychologist Natalie Walders
Abramson, PhD. “It requires vigilance, diligence and determination. Those characteristics
are not inherent to the teenage psyche. They’re having to make an investment in their
future. Developmentally, the future is the next ten minutes. For some of these kids, they
don’t know where to start. They’re not even sure why to start.”
Add to that the results of the landmark TODAY study, led by Children’s Hospital Colorado
Chief of Pediatric Endocrinology, Philip Zeitler, MD, PhD, published in The New England
Journal of Medicine in 2012. * The study compared kids with type 2 diabetes on metformin
to those who also received a second