Doctors and researchers from the CDC, NIH and WHO joined others for the Post's Diabetes Summit in Washington to discuss ways of averting a disease that affects nearly 30 million Americans. (Meena Ganesan/Washington Post Live)

Ann Albright
Director, Division of Diabetes Translation, Centers for Disease Control and Prevention

“We’ve got this looming iceberg of about 86 million people with pre-diabetes. Blood sugar is higher than normal, but not yet high enough to constitute diabetes, but they’re at very high risk for developing Type 2 diabetes and having a heart attack or a stroke.

“What does diabetes cost all of us? It’s the number one cause of adult blindness, number one cause of kidney failure, number one cause of amputation, huge contributor to heart attack and stroke.

“But there is good news. There are things we can do to get on top of that and to not have this be the outcome for those who have diabetes. We can both prevent or delay Type 2, and we can certainly prevent and delay the complications.

“Probably the most general way to describe diabetes is that the body is either unable to produce enough insulin or use the insulin it produces properly. There are different forms of diabetes. Type I is considered an autoimmune disease in which insulin-producing cells called beta cells are destroyed by processes we’re still trying to understand better. And in Type 2 diabetes, people actually become resistant to their insulin. It doesn’t work properly. And then, of course, we have gestational diabetes, which happens during pregnancy, and that’s almost like a preview. Women who have gestational diabetes are at high risk for developing Type 2 later in life.

“Probably about 20 percent of people with Type 2 are not overweight or obese. And those of Asian heritage are likely to develop their diabetes at a lower body weight. There are people who will develop diabetes and they aren’t obviously overweight or obese.”

The Post's Alison Snyder, independent consultant Nikki Tyler, and Sonal Shah, executive director of the Beeck Center for Social Impact and Innovation at Georgetown University, discuss impact investing in the health field. (Meena Ganesan/Washington Post Live)

Nikki Tyler
Independent business consultant

“Our idea was to bring in private investors who could provide the capital to scale the Diabetes Prevention Program in more communities and then the investors’ payback could actually be directly attributed to the outcomes in terms of health-care savings that are accrued as a result of lower progression to Type 2 diabetes. So we were very much trying to bring in the private sector and think of new and innovative ways to finance health-care interventions and outcomes.”

Sonal Shah
Executive director, Beeck Center for Social
Impact & Innovation, Georgetown University

“The research is already out there about what is preventable, and we’re not even acting on it. Why not? We’re only paying for treatment, and why shouldn’t we be paying for prevention? And I think the private sector gets that, and so insurance companies understand it, and certainly the government understands it, but it’s a cost.

“We live in silos. Health care. Finance. Hospitals. The challenge is collaboration. How do you bring the right people to the table who include those who know the research, that include the communities, that include the private sector that is thinking about this, that include the finance folks? How do you bring that together to have a conversation to actually solve the problem?

“The challenge is bringing the right groups of people together in a collaborative model that can translate between the different parties, because they all speak different languages.”

Robin Dorsey of the American Diabetes Association joins 11-year-old Patrick Swingle and his mother Vivian Swingle to discuss the daily struggle of having diabetes. (Meena Ganesan/Washington Post Live)

Robin Dorsey
Volunteer/ambassador, American Diabetes Association, National Capital Area

“I was diagnosed with diabetes seven years ago, when I was pregnant with my son. I was tired after I ate a meal. I was so sluggish and then would often fall asleep. And I was wondering why I was so tired all of a sudden, because I wasn’t tired before I ate.

“So I went to the doctor. They did the glucose test.

“It is a struggle every day. When I read [food] labels, one of the key things that I look for is the carbohydrate count. Most people don’t pay attention to that, so for a can of soup, the carbohydrates may be 45 grams or higher. Well, that’s extremely high, because I was told you’re only supposed to have less than 15 grams per meal. So if I eat this whole can of soup, my sugar is going to be extremely high, I’m going to feel very fatigued, I’m not going to feel well, I’m going to have to take additional medication because now I made a poor choice. So now it’s about making better choices, because I don’t want to be sick.

“When I first was diagnosed, a lot of people would say, ‘Well, if you just lose weight, then you wouldn’t have diabetes.’ And I tell people that if it was that easy, millions of Americans wouldn’t be obese.

“The first stage for me was denial, because they told me it was gestational and it will go away. The second stage, once I realized it wasn’t going to go away, was depression, because I felt like I was all alone. And the last stage for me was acceptance, when I realized and understood either I’m going to wallow in my denial and depression or I’m going to change my habits and what I’m doing.

“I was able to make the adjustments, research about diabetes, find out about, to get that information, and start getting that outreach and support that you really do need, because you’re not alone. There’s 29 million people.”

Patrick Swingle
Age 11, of Virginia

“ If I hadn’t gotten [Type 1] diabetes, I would be able to do sleepovers. I’ve met different friends. It’s changed really how I eat and how I live. Basically, it’s changed everything. [If my blood sugar is too low], I feel shaky, sort of. I need to sit down. I feel sweaty. When my blood sugar is too high, I feel nauseous usually.

“Having diabetes is difficult. And sometimes other 11-year-olds or other kids my age will think it’s not what it actually is. They think it’s something different. You don’t give [Type 1] diabetes to yourself. It just comes on.

“I hope that we get a cure.”

Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, and Judith Fradkin, director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institutes of Health, talk about the need to identify those with pre-diabetes. (Meena Ganesan/Washington Post Live)

Judith Fradkin
Director, Division of Diabetes, Endocrinology and Metabolic Diseases, NIH

“The first thing we need to do is find everybody who has diabetes and who has pre-diabetes, because there are so many effective things that they can do to change the course of their health.

“If we find out that there’s a virus or a bacteria that puts people at risk or protects against Type 1 diabetes . . . we’re hoping to be able to develop a vaccine, if we can figure out what the cause is. If we can find out a dietary component, we might be able to change diets of people who are at high risk. But even now, we can offer high-risk families screenings so that they can at least detect it early.

“It makes a huge difference even to postpone the onset of diabetes by a few years, because in general, the complications of diabetes can take decades to develop.

“We know that the most tragic thing is these young children who in adolescence are developing Type 2 diabetes. Type 2 diabetes used to be called adult-onset diabetes because it was never seen in kids, and now, all of a sudden, we’re seeing this surge of Type 2 diabetes in children.

“And what’s really, really scary about that is that in these kids who develop diabetes earlier, it seems to progress much faster. You know, they stop responding to the initial medical treatment and require more aggressive medical treatment earlier. They are already in adolescence and young adulthood showing signs of heart disease. So delaying diabetes is a very, very important goal.”

Robert Ratner
Chief scientific and medical officer, American Diabetes Association

“If we don’t change the environment that we’re in and the approach that we take, it’s going to be devastating. We’re basically looking at 1 in 3 people in the United States having diabetes, in some ethnic groups 50 percent. That’s an unsustainable condition.

“Diabetes has been dealt with as a medical problem for the past 100 years. We really need to start thinking of it as a public health problem.

“For example, antibiotics cure a lot of infections, but if we didn’t have clean water and sewage, the antibiotics wouldn’t help at all. That’s the public health concern. We have an environment now that leads to obesity and diabetes. It used to be that food was expensive and exercise was a part of your daily living, because you were doing manual labor. Now, food is cheap.

“And now you have to pay a membership to go to a gym because you don’t walk to work. The streets are not necessarily safe. The green spaces have been diminished, so we are really looking at a social-environmental concern here that we need to deal with.”

Antonio Convit, deputy director at the Nathan Kline Institute and professor at the New York University School of Medicine, and Robert Ratner, chief scientific and medical officer at the American Diabetes Association, discuss what's necessary to mitigate the effects of diabetes. (Meena Ganesan/Washington Post Live)

Antonio Convit
Deputy director, Nathan Kline Institute; professor, NYU School of Medicine

“You’d have to live under a rock not to know that you need to eat better and move more.

“When you give kids in particular a goal that they can work toward, rather than just their waist size, that has a big empowering effect. It changes the conversation from “You’re fat” to “How do I improve my health?”

“We go into a school and we measure the height and the weight of all the kids. Then we target the kids who are carrying excess weight, because those are the ones who are at higher risk for developing medical problems . . . and we share with them and their families a detailed medical report with common-sense advice as to how to improve those medical numbers.

“The important thing to note is that the earlier you start with changing your lifestyle and losing those few pounds, the more likely you are to succeed. For example, we know that if an adolescent loses significant weight, they’re much more likely to maintain that weight loss as an adult.

“Small, little things that you incorporate into the way you live every day, those are the things that will have an impact down the road, particularly for kids.”

Matt Longjohn, national health officer for the YMCA, and Steve Tarver, president and chief executive of the YMCA of Greater Louisville, discuss efforts in Kentucky and around the nation that encourage healthier lifestyles. (Meena Ganesan/Washington Post Live)

Matt Longjohn National health officer, YMCA of the USA

“In response to the epidemics of diabetes and other chronic disease, the Y is engineering itself to be an organization that helps provide solutions to people looking to experience behavior change and find sustainable, healthy patterns in daily routines.

“The Y has about 2,700 branches, 10,000 program sites nationally. More than 80 percent of U.S. households live within five miles of a Y.

“The trigger of reducing new cases of diabetes seems to be about a 5 percent to 7 percent weight loss and achieving 150 minutes of moderate to vigorous physical activity a week.

“This is a lifestyle change. This is not just, ‘How do I lose 5 percent in the next 10 days by starving myself or dehydrating myself?’ This is about making changes to daily routines.”

Steve Tarver
President and chief executive, YMCA of Greater Louisville

“In Kentucky, between 1991 and about 2011, our obesity rate doubled, our diabetes rate doubled, so we’re headed for a train wreck.

“The [YMCA] program is very grass roots in nature. It deals with portion control, about observing barriers, about weight loss, about logging your food intake.

“The magic of the program is that it is dialogue-based, led by regular people. It is the social connectedness among the participants in the program and the mutual accountability that goes with weekly weigh-ins and comparing food logs and discussing what is it that keeps you from avoiding fast food.

“We’ve got all of our Christmas shopping coming up, so don’t spend 10 minutes searching for that close parking place. Park far away and take the 10 minutes and make the walk. Take an extra set of stairs. It all counts.”

(Meena Ganesan/Washington Post Live)

Alberto Barceló
Adviser on noncommunicable diseases, Pan American Health Organization, Regional Office of the World Health Organization

“There is going to be an increase in every region of the world in the number of people with diabetes, but the major increase is expected to happen in Africa, where we have a very low prevalence now.

“Type 2 diabetes is on the rise because of changes in lifestyle and increases of unhealthy nutrition and lack of physical exercise. A lot of people are spending a lot of time on the computer or sitting at home watching TV. And physical exercise [has decreased] in our schools and also in the general population.”

Rep. Diana DeGette is co-chair of the House Diabetes Caucus. (Meena Ganesan/Washington Post Live)

Rep. Diana DeGette

”Ultimately, I think CMS [Centers for Medicare and Medicaid Services] is the one that sort of sets the gold standard. So, for example, if they say, ‘We’re not going to reimburse for diabetes education,’ then people don’t do it. And if they say, ‘We are going to reimburse,’ then that sets the standard for the industry. That’s why the Diabetes Caucus [in Congress] is really working, in particular, on the diabetes educators, to have that reimbursed.

“We really need to shift our paradigm to think about wellness versus just treatment. There is a growing consensus in Congress — and in the administration — that that’s what we need to do. We need to focus on wellness.”

Michele Mietus Snyder, a cardiologist and co-director of the Obesity Institute at Children’s National Health System, talks with Dominick Charbonneau and Briana White. The two were at risk of developing diabetes when they went to the institute’s IDEAL (Improving Diet, Energy and Activity for Life) Clinic in Washington. They’re managing their pre-diabetes through diet, exercise and, in White’s case, bariatric surgery. (Meena Ganesan/Washington Post Live)


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