David Schade, MD and Karwyn Gustafson, RN
Dr. Schade, professor of medicine and chief of the Division of Endocrinology  and Nurse Gustafson, program coordinator for the Diabetes Research and Treatment Center work with a patient with diabetes.

At a time when the death rates from life-threatening diseases like cancer, heart disease and stroke are declining in the United States, diabetes continues to kill an increasing number of Americans each year. In 1999, according to the American Diabetes Association, the disease contributed to the deaths of more than 200,000 Americans.

Beyond the staggering tally of deaths, diabetes can also lead to multiple complications, according to David Schade, M.D., professor of medicine and chief of the Division of Endocrinology at the UNM School of Medicine. "Hypertension, heart disease, renal failure and nerve damage are just some of the complications these patients must endure," said Schade, noting that many of these patients require constant care and are unable to continue working because of their health.

New Mexicans have been hit particularly hard by this devastating illness. The New Mexico Department of Health reports that more than 120,000 New Mexicans, including 17 percent of all New Mexicans older than 40, have diabetes.

"One reason for New Mexico's high rate of diabetes is our unique demographics," explained Schade. Forty-two percent of New Mexico's residents are Hispanic and 10 percent are Native Americans, two groups at greater risk for developing diabetes. The state's scattered population and pockets of poverty also contribute to the problem, said Schade. "These conditions make providing health care an ongoing challenge," he said.

Prevention is the Key

The state's high prevalence of diabetes is alarming, especially since the disease can be avoided. "In 90 percent of the population, diabetes is a preventable disease," said Schade. A recent Diabetes Prevention Program Research Group study found lifestyle changes and preventive drug therapy significantly reduced the occurrence of type 2 diabetes in people considered at high risk for developing the disease. The study, which involved more than 3,000 participants from around the country, found that lifestyle changes alone reduced the incidence of diabetes by nearly 60 percent. For a disease that affects hundreds of thousands of Americans and costs billions of dollars each year to treat, the discovery that prevention is possible is exciting news.

"We were very fortunate to be involved in this study," said Karwyn Gustafson, R.N., program coordinator for the Diabetes Research and Treatment Center at UNM. "Many states didn't have access to the prevention trials as we did. We had 12 staff members comprised of physicians, nurses, nutritional and behavioral experts and support staff working on the study for four years, so we are on the cutting edge of new research for diabetes."

But the discovery that lifestyle changes and preventive therapies can reduce diabetes is only half the battle, according to Schade. "The problem is that prevention is a relatively new concept," he said. "Physicians who graduated from medical school more than a few years ago may not even know about recent prevention research. They are very busy just keeping up with the number of patients they see-it's impossible for them to stay up to date on all of the current research and literature." That's where the UNM Health Sciences Center-and its mission to provide education-comes in.

"Our challenge is to find the most effective ways to communicate the importance of prevention efforts to the community at large, and especially to primary care physicians," said Schade. "It's crucial that we interact with the medical community across the state so they can improve treatment efforts for their patients."

Although preventive efforts will certainly reduce the occurrence of diabetes, they cannot help the more than 120,000 New Mexicans already diagnosed with the disease. "Diabetes has become a complicated disease to treat," noted Schade. For these people, innovative and effective treatments are the answer. Unfortunately, the ever-changing variety of new treatments available every year makes it difficult for physicians to keep up.

This, stressed Schade, is another reason why communicating and providing educational opportunities for health care professionals statewide is such an important part of the UNM HSC's mission. "We are a valuable resource and must play a major role in the solution," he said.