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Diabetes is a stubborn adversary

The disease, affected so greatly by lifestyle, is an ongoing challenge for the healthcare system — and for community clinics in the forefront of reform efforts.

January 06, 2013|By Anna Gorman, Los Angeles Times

One by one, the diabetic patients reluctantly stepped on the scale in the basement of a South Los Angeles clinic. Nearby, a nurse scribbled numbers on a chart.

Camara January, 31, her round face framed by a sparkly headband, held her breath. The number stopped at 245 pounds. "That's not good," January said. Tracy Donald, 45, stepped up. Just under 240 pounds. "That is wrong," she said. Ramon Marquez, 62, tall and clean-shaven, methodically took off his watch, his cap and his shoes. 170 pounds. Ramon strips down to almost nothing, the others jokingly complain.

They are among those who come each month to the To Help Everyone (T.H.E.) Clinic, hoping to finally gain the upper hand on their diabetes, a disease wreaking havoc on their bodies — and their community. Several have been hospitalized. Some have seen relatives die from complications. All have struggled to manage blood sugar levels that spike and plummet to ominous extremes.

FULL COVERAGE: T.H.E. Clinic in South L.A.

A chronic illness that can lead to heart attacks, blindness and kidney failure, diabetes is exploding across the United States and raising enormous obstacles to the Obama administration's drive to control costs and reform the healthcare system. In California alone, the disease costs taxpayers and businesses roughly $24 billion annually. One in seven California residents has diabetes — a 32% increase in the last decade.

"This is a train going in the wrong direction," said Dean Schillinger, a UC San Francisco Medical School professor and medical officer at the California Diabetes Program, run by the university and the state public health department.

PHOTOS: T.H.E. Clinic: Battling diabetes

Community health centers like T.H.E. Clinic are a crucial front line in the federal government's war against diabetes. They're charged with slowing the advance of the disease, which disproportionately affects poor patients whose care may be taxpayer-funded.

To do so, clinics must get millions of patients to change deeply ingrained eating habits, embrace regular exercise regimens and better manage their health to avoid unnecessary hospitalizations.

Many low-income, urban patients struggle with the willpower challenges afflicting diabetes sufferers everywhere. But their struggle is often complicated by limited understanding of the links between lifestyle and blood sugar levels, along with fewer safe, affordable and convenient options for healthy activities and fresh food.

"The approach of telling people they need to lose weight and exercise is clearly not working," said Martha Funnell, past chairwoman of the National Diabetes Education Program.


Like her mother and grandmother, 17-year-old Charnay Winbush has diabetes. She injects herself with insulin five times a day and wears a bracelet identifying her illness. But Charnay often tells people she isn't diabetic.

Without her injections, she feels weak and tired. When her blood sugar levels climb, she gets extremely thirsty and can't stop sweating. One incident sent her to the emergency room this summer. "I was scared," she said.

Doctors at T.H.E. Clinic tell Charnay she needs to lose weight, but she continues to gain. She keeps small bags of candy in the refrigerator next to her insulin. Counting calories brings unwelcome memories of math class, she says. The only exercise she likes is playing virtual tennis or bowling.

The diabetes battle permeates almost every aspect of T.H.E Clinic's routine. Patients are greeted in the waiting room by television programs about the disease. They are routinely tested for it, counseled about how to prevent it and referred to nutritionists and diabetic education groups to manage it.

Research shows such efforts can produce results. Patients surrounded by support and education programs do better at controlling their blood sugar, eat more healthfully and use their medication as recommended.

At the Saturday session, retired nurse Emily Moore handed out a soul food cookbook with healthy recipes. Patients shared about their favorite types of exercise. One woman said she liked dancing to disco music, another announced she was going to Zumba classes.

The sessions began as a diabetes education class but soon morphed into a less formal support group, said M.D. Donnell, education manager at T.H.E. Clinic. Patients say they come for the snacks, the nutrition advice and the camaraderie. James Hicks, whose leg was amputated after a diabetes-related infection, said he serves as a cautionary tale for others. "You never want to get this far," he said.

Despite the intense focus, a quarter of the clinic's diabetic patients haven't brought the disease under control, records show. Cynthia Francis, a physician assistant, dispenses sober warnings along with hope. "You have to be real with them," she said. "You have to tell them that managing their disease is a life-or-death situation."

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