Henry Rodriguez, MD, clinical director of the USF Diabetes Center, joined U.S. Rep. Kathy Castor at USF recently to host a roundtable discussion by community experts and advocates taking action to treat and prevent diabetes.

The Oct. 12 event in the USF Student Marshall Center was conducted in collaboration with the Arthur Green Jr. Memorial Foundation, LIFT Health, Inc., and the American Diabetes Association (ADA).   It drew representatives from across the Tampa Bay area, including the USF College of Public Health, Tampa General Hospital, JDRF, the YMCA, Tampa Family Health Centers, and the Pinellas County Urban League

In a discussion moderated by Rep. Castor, the participants talked about the need to raise awareness about the growing epidemic and how they might work together more effectively to maximize resources for people with diabetes and prediabetes. In Florida, diabetes affects more than 2.3 million people in Florida, or 13 percent of the state’s population. The ADA estimates that people with diabetes have medical expenses 2.3 times higher than those without diabetes. The metabolic disease a leading cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.

Dr. Henry Rodriguez, clinical director of the USF Diabetes Center, joined U.S. Rep. Kathy Castor in a recent diabetes roundtable discussion that brought together community providers and advocates.

“Diabetes is very expensive,” said Rep. Castor, adding that the cost of diabetes care can cause financial havoc to the health care system and personal lives. “We need to fight for research so that USF and other places around the country have the funds they need to tackle this disease.”

Rep. Castor introduced Dr. Rodriguez as a member of the team headed by Dr. Jeffrey Krischer, the world’s top-funded National Institutes of Health principal investigator with a longstanding commitment to diabetes research. Dr. Krischer and his team are making powerful strides in organizing, coordinating and analyzing clinical trial data in type 1 diabetes and related autoimmune disorders, which can lead to advances in treatment and prevention.

“Diabetes is a club you don’t want to belong to,” said Dr. Rodriguez, who focuses on prevention and clinical management of type 1 diabetes through partnerships with primary care providers and research collaborators. “It’s critically important that we coordinate and collaborate across the spectrum in fighting this disease.”

Also at the discussion was Lena Young Green, whose husband Arthur died in police custody in 2014 after suffering an acute hypoglycemic episode. Green’s death led to a Florida law providing more training for law enforcement officers regarding how to recognize and respond to diabetic emergencies, in which a person’s symptoms can resemble those of someone who is intoxicated or impaired.  Also present was State Rep. Ed Narain of Tampa, who helped sponsor the legislation.

Roundtable participants spoke about the need to marshal and coordinate resources to help prevent Type 2 diabetes in children identified as prediabetic and to motivate patients and their families to use the tools they need to manage diabetes on a daily basis.

Janice Zgibor, PhD, an associate professor in the USF College of Public Health, who recently published a book on integrated diabetes care, challenged providers to “think outside the traditional medical model” in breaking down the barriers to effective diabetes treatment and prevention.

For example, it may work better to bring diabetes education to the patient at their primary care providers’ offices rather than refer patients out to other locations, Zgibor said. “People trust their primary care doctors and like that they don’t have to make extra appointments.”

The roundtable drew representatives from across the Tampa Bay area, including the American Diabetes Association, JDRF, the YMCA, Tampa General Hospital, Tampa Family Health Centers, and the Pinellas County Urban League

Dan Vukmer, JD, senior associate vice president of network integration for USF Health, suggested the group may want to include representatives from managed care and health insurance plans, who have an vested interest in keeping a community healthy, in future discussions.

Pattye Sawyer-Hampton, MA, director of health initiatives for the Pinellas County Urban League, emphasized the importance of family support in helping people manage diabetes.

“When someone lives with diabetes, it affects everyone in their family,” she said. “The patient needs continual family support to eat right and exercise, monitor their blood sugar and keep doctor appointments.”

Rep. Castor concluded the gathering by outlining some action steps, including her intent to share with the diabetes roundtable participants information about federal grant funding available and how to apply and to reach out to primary care providers and health plans.

Photos by Ryan Noone, USF Communications & Marketing

More than 80 million Americans have prediabetes, increasing their chances of developing type 2 diabetes and cardiovascular disease, according to the Centers for Disease Control and Prevention.

USF College of Public Health’s Dr. Janice Zgibor, associate professor in the Department of Epidemiology and Biostatistics, and research colleagues set out to determine if weight loss and cardiovascular risk reduction was maintained following a lifestyle intervention.

Self-selection of a lifestyle intervention may be the key to reducing a patient’s risk of developing diabetes and its associated health complications, according to results. Their study, “Influence of Patient-Centered Decision Making on Sustained Weight Loss and Risk Reduction Following Lifestyle Intervention Efforts in Rural Pennsylvania,” is published in the March 2016 issue of The Diabetes Educator.

Zgibor and colleagues examined eight rural Pennsylvania communities, focusing on individuals who were obese, but did not yet have diabetes.

Individuals were split into groups based on three different types of lifestyle interventions: a face-to-face meeting, instructional DVD or internet-based intervention. A fourth group was allowed to self-select, choosing one of the three intervention modalities of their preference.

Participants made in-person visits at three, six, 12 and 18 months after enrolling in the study to get their height, weight, blood pressure and waist circumference measured. Blood samples were also collected for analysis of cardiovascular risk reduction changes, including changes in glucose and triglycerides. (Photo courtesy of Dr. Gretchen Piatt)

“We cast the net broad and looked at the comparative effectiveness of different ways to deliver a diabetes prevention curriculum,” Zgibor said.

The study reached a total of 434 participants who were assigned to one of the four lifestyle intervention modality groups.

Despite the modality, all content for the intervention was the same, according to Zgibor.

Participants were asked to lose at least five percent of their body weight and to decrease at least one cardiovascular disease risk factor following the intervention.

Training for the intervention was provided by the University of Pittsburgh Diabetes Prevention Support Center and consisted of a 12-week comprehensive lifestyle behavior change program adapted from the lifestyle intervention used in the national Diabetes Prevention Program.

More than half of all participants in each intervention group lost at least five percent of their total body weight following the intervention and maintained that loss at their 18-month follow-up meeting, losing an average of 20 pounds.

Trained community preventionists delivered all interventions and community peer leaders provided informational and emotional support to participants. (Photo courtesy of Dr. Gretchen Piatt)

The group with the largest achievement and maintenance of weight loss was the self-selection group, according to Zgibor.   They were more than twice as likely to maintain that weight loss at 18 months.

They found the key to not only reducing diabetes and cardiovascular risk, but also sustained reduction of that risk, is self-selection of the modality in which the lifestyle intervention was delivered.

“That’s where we found the most impact, when people can decide what they want do to, it tends to be most effective,” Zgibor said.

The study, called REACT, is one of the first to compare the long-term effectiveness of different modalities of delivering lifestyle interventions in multiple, underserved, rural communities.

“This is the first of its kind to look at people out in the community, in the real world, and what helps them to sustain weight loss,” Zgibor said.

Dr. Gretchen A. Piatt, assistant professor at the University of Michigan School of Public Health and principal investigator for the REACT study, said this research added to an area in need of illustrating how lifestyle intervention self-section works at the community level.

“We were able to take an intervention that was shown to be effective in large clinical trials and effectively translate it in a community setting for people who were struggling with their weight and diabetes risk on a daily basis,” Piatt said.

Zgibor, who joined the COPH in late 2015, hopes to expand upon this research in Tampa to examine hypertension and obesity in low-income minority women of childbearing age.

“We want people from those communities to tell us what they need and have them be part of the development process,” she said.

She will be holding focus groups with members of the community to determine intervention possibilities.

She appreciated being part of the REACT study because it provided her proof that lifestyle interventions play an important role in overall health and can be sustained.

“Given the huge problem that obesity is in this country, this tells us that something can be done,” she said. “There is a lot of awareness around healthy eating and chronic conditions that go along with obesity, but there is not enough awareness of things that can work, so understanding the challenges and meeting the needs is the message and this was the first step at getting at that.”

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Piatt, G.A., Seidel, M.C., Powell, R.O., Zgibor, J.C. Influence of Patient-Centered Decision Making on Sustained Weight Loss and Risk Reduction Following Lifestyle Intervention Efforts in Rural Pennsylvania. The Diabetes Educator [Internet]. 2016 Mar 8 [cited 2016 May 5]; Available from: http://tde.sagepub.com/cgi/doi/10.1177/0145721716636962

Story by Anna Mayor, USF College of Public Health