Changing Whole Towns to Reduce Type 2 Diabetes: Itamar Raz

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This is the second part of my interview with leading diabetologist, Professor Itamar Raz. Raz is the director of the Hadassah University Hospital’s diabetes unit and one of the world’s leading researchers and clinicians in diabetes.

In addition to being close to preventing Type 1 diabetes, Raz is working to protect the heart and kidney from diabetic complications, educating doctors how to treat patients with diabetes and changing towns across Israel to improve lifestyle behaviors.

Q: Tell me about the research you’re doing in Type 2 diabetes 

Itamar Raz: I’m working on a number of things. We’re developing a drug to decrease the muscles’ resistance to metabolizing glucose. You know of course Type 2 is a situation of insulin resistance. We’re developing small proteins that may overcome this insulin resistance.

Mostly I’m doing clinical research to protect the kidney and the heart from complications. Now I’m running studies that show certain drugs can protect the kidney from deterioration. 

For the heart it’s more complicated. We have to show the FDA that while a drug can reduce blood sugar we need to assure that it doesn’t cause heart damage. Most Type 2 patients die and suffer from cardiovascular events. For one of the recently-developed oral hyperglycemic drugs (saxagliptin) we are running a very large study, 16,500 people at 800 centers, with a leading cardiology group in Boston.

Q: What else are you working on that you’re excited about? 

IR: Here in Israel I was nominated by the Ministry of Health to head the National Council of Diabetes. That makes me responsible for all the policy and treatment of diabetes care. In this capacity I am expanding the knowledge of the general doctor on diabetes treatment.

Ninety percent of diabetes patients in Israel and worldwide see a general practitioner (GP), but there’s so much diabetes knowledge and experience the GP doesn’t have. Especially with the vast array of new drugs available for treatment. So we’re teaching them when to start insulin, how to start insulin, which drug to use first, how to combine drugs and many more things like this. 

We run large scientific meetings in Europe, Asia and Latin America where we sit everybody together, diabetologists, nurses, doctors, dietitians, social workers, psychologists, representatives from organizations like the JDRF, and we talk with them about how to improve treatment and care. We’re also publishing that knowledge in medical journals like Diabetes Care to make it accessible to more doctors and nurses.

Members of the OECD, that’s an organization that works at improving the economy — and they’re looking closely at medicine — they just came here to Israel to learn one thing from us. How we deal with diabetes. We are very good at it.

Q: Are you also teaching doctors that Type 2 diabetes is not just about medicine but also behavior change?

IR: Yes, and I completely agree with you. If you want to cure Type 2 diabetes, you must change your lifestyle. We see it in evidence-based studies. Do more exercise, eat properly and you have a 60 percent chance you’ll be cured of diabetes. Take a drug and it’s only a 30 percent chance and over a few years most people deteriorate. But no one has taught doctors how to help patients embrace a healthy lifestyle. Many doctors themselves are fat so doctors don’t put enough emphasis on lifestyle.

In Israel we’re changing people’s lifestyle by changing whole towns. We learned from the U.S. and Britain that government cannot change people’s lifestyle. You have to change the environment.

People need places to exercise. If a person works they should have an hour to stop and do exercise. You can’t just tell somebody, “You have to run five miles a day!” You have to give him that ability.

So we are in the process of instituting what we hope will become a nationwide program in Israel called “Healthy Living.” We went into 10 towns and began making changes. We are using one town, Ashdod, which has about 250,000 people as a model.

Last year we began creating opportunities for people to exercise. We went to the factory where many people work and now they serve healthy food and give an hour off for exercise. We are changing drinks in school to only water. We are going into people’s homes and explaining the best foods to have in their refrigerator. We are making a green line in the supermarkets to show where the healthy food is. And we’re trying to make healthy food cheaper than unhealthy food. Next year we will have another three towns and each year more.

I’m a diabetologist, why am I doing this? I think we have to do this. And I am trying to do this without too much money and in a way that two or three years from now the government won’t have a choice but to continue.

Q: What are you most proud of in all that you’ve done?

IR: That I can sit with each one of my patients and after five or 10 minutes I can change them from people who are terribly worried to being less worried and more relaxed.

I see about 50 new patients a week. At the end of the day, after all these things I do, I’m just a simple doctor who wants to help people and wants to do good.

I came away from my entire interview with Professor Raz awed that we may actually be so close to preventing Type 1 diabetes and deeply curious what we may yet see emerge in the next few years.

Originally published on Huffington Post.

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