Stepping Up the Fight Against a Deadly Epidemic

Assistant professor Iris Mercado, left, and professor America Trinidad set the pace for the Hostos walkers near Yankee Stadium.

The CUNY Campaign Against Diabetes is helping New York control its biggest health crisis — via education and action within the University community and beyond.

High-spirited East Harlem is the neighborhood most devastated by New York City's deadliest epidemic: diabetes. Angelica Santana, who lives there among numerous relatives with the disease, aims to change that grim statistic — starting at home. For a recent gathering of family members, including many who speak only Spanish, the 23-year-old bilingual student in Hunter College's public health nutrition master's program baked a veggie version of Puerto Rico's traditional fried empanadas. "I really wanted to show them how easy it is to make small steps toward a healthier lifestyle," she said.

Across the Harlem River in the South Bronx, where the city's highest rate of obesity also triggers diabetes in many residents, Hostos Community College students, faculty and staff are taking steps toward better health, as well. They're joining brisk 30-minute walks scheduled four times a week to reduce the high odds they, too, might get this potentially fatal disease. In bad weather, they walk inside a building with a long, open flight of lobby stairs — which dynamic group leader/assistant health professor Iris Mercado scales two at a time.

These are just two examples of how the year-old CUNY Campaign Against Diabetes is mobilizing campuses to help the city and the state control this major health crisis, which disproportionately afflicts Hispanics, blacks, Asians and residents of low-income areas.

If diabetes hasn't yet touched your life, chances are it will soon. One in every four New Yorkers has the disease or is at high risk of developing it. In the last eight years, the numbers surged 250 percent and the death rate nearly doubled. One of every five health care dollars citywide is spent on people who have diabetes. Most of them have uncontrolled high blood pressure, cholesterol or blood sugar — which puts them at increased risk of complications including vision problems, kidney failure, heart attacks, strokes, amputations. Such medical emergencies often are the first clue people get that they even have diabetes — which can kill slowly, silently, without a wake-up call. Vague symptoms such as increased fatigue, hunger, thirst and irritability can signal diabetes but are frequently ignored. In hectic New York, who doesn't feel that way?

What brought us to this alarming point is that the city, like the nation, is simply getting too fat. Nearly 60 percent of New York City adults and more than 40 percent of its elementary school children are overweight or obese. So are more than 80 percent of diabetics. Stop the surge in obesity and we can stop the most common type of diabetes, experts say. But if these two intertwined epidemics continue, researchers predict that the life spans of our children and grandchildren will be shorter than ours.

There is no cure for diabetes but it can be controlled and even prevented, often just by eating more healthy and less unhealthy food and exercising more. Spreading that positive message is the mission of the CUNY Campaign Against Diabetes, developed by the University's Urban Health Collaborative. The five-year plan of research, education and action eventually will reach throughout the CUNY community of 500,000 students plus 37,000 faculty and staff — as many as a third of whom could be diabetic or pre-diabetic based on citywide numbers.

Working in conjunction with similar city, state and even international initiatives, the University's campaign is underway at three pilot schools — Hunter, Hostos and Medgar Evers Colleges. Long-term goals are to reduce the number of students, faculty and staff on all 23 campuses, as well as their family members, who have uncontrolled diabetes; prevent others from getting the disease; and leave city institutions better equipped to control and prevent it.

"The Campaign Against Diabetes demonstrates CUNY's potential to become a national model for public universities to contribute to solving our nation's most intractable health and social problems," said campaign co-founder Nicholas Freudenberg, distinguished professor of public health at Hunter. Freudenberg also leads the Diabetes Action Team that will prepare hundreds of students to carry the message about changing attitudes and the local environment to bring about healthier lifestyles and better health care. The campaign has also reached abroad, via  collaboration with London Metropolitan University, England's CUNY equivalent; a recent joint forum at CUNY was titled "A Tale of Two Obese Cities."

"CUNY leadership in diabetes education will continue to grow as we further develop the University's new School of Public Health, which will be located at Hunter College," said Chancellor Matthew Goldstein, who established a task force on diabetes awareness and prevention and designated coordinators on all CUNY campuses. "There will be new opportunities for research, drawing upon the expertise of our distinguished faculty and talented students."

What exactly is diabetes, and why is it so dangerous? It's actually not a single disease but a group of chronic conditions marked by too much sugar in the blood. Normally the food we eat gets broken down into glucose. Insulin, a hormone produced in the pancreas, helps get this form of sugar into your cells to be used for energy. If your body doesn't produce enough insulin, or can't use what's made, sugar from your food stays in the blood, damaging cells. There can be a genetic component to diabetes, but "environmental factors" such as the foods you eat and your physical condition, usually are the triggers.

Type 2 diabetes, the most common type, accounts for up to 95 percent of cases and is increasing at a staggering rate. It was once called adult-onset diabetes because people didn't develop it until later in life. But as more children are getting super-sized, they are also developing this type of diabetes; thus the name was changed. People with Type 2 diabetes develop insulin resistance due to overweight and can no longer use the insulin they produce. This condition usually is controlled by diet, exercise and oral medications.

Type 1 diabetes was previously called juvenile-onset diabetes because people generally have it for life. Their body doesn't make insulin at all, or not enough of it.

There has been no recent increase in this type, which requires a daily protocol of insulin injections or infusions to control it.

A third variety, gestational diabetes, develops in a small percentage of women whose blood sugar rises during pregnancy. Although the blood sugar levels usually resolve after the birth, these mothers — and their children — have a greater risk of developing Type 2 diabetes, often not discovered for many years.

That was the case with CUNY administrative assistant Robin Taylor, whose Type 2 diabetes was diagnosed in 2008, almost 14 years after her son was born. The 52-year-old Taylor, who recently attended self-management classes at Hunter, is still learning how to read food labels and gauge how certain foods affect her blood sugar. But she's happy that in less than four months she lost nine pounds.

As well as watching what and how much she eats, she takes long walks with a group twice a week and with a friend most other days, and gets off the train two stops early. She's also learned ways to "de-stress" during hectic times that cause blood sugar to spike ("do breathing exercises, close the door, listen to soothing music…"). She is taking insulin in addition to oral medication now but hopes it will be only until her condition is under control. She also shares health tips with her husky 14-year-old son, Lloyd, an avid swimmer. "His sugar is fine," she said.

Guided by the campaign's catchy slogan — "Move more and eat less" — students, faculty and staff on the pioneering campuses have started nutrition clubs, support groups and health fairs in addition to walking programs like the one at Hostos.

Participants in leadership workshops also are evaluating their own and family members' risk factors for diabetes, assessing University-wide healthy food and exercise options, learning the latest self-management techniques and sharing their knowledge with family members, students, friends, co-workers and their community to begin changing attitudes and environments. East Harlem native Angelica Santana not only gives diet tips to her family, but has approached a local community center about providing healthier snacks for its senior bingo patrons.

Training sessions are led by CUNY Diabetes Action Team members Hollie Jones, a health psychologist at Medgar Evers, and campaign coordinator Lorraine Mongiello, a certified diabetes educator and a student in the University's doctor of public health program. Each student in the leadership program receives a $300 stipend and many have received additional funding for individual projects such as designing posters, preparing a cookbook and initiating an elementary school obesity program.

Making diet and lifestyle changes takes time, but you don't have to do it alone. Many free local programs will help you stop smoking, which raises the level of artery-clogging fats and cholesterol and thus ups the risk of heart disease and diabetes. CUNY's Diabetes Action Team can provide advice on losing weight, crucial because excess body fat means more fat in your blood. It also causes your body to retain sodium, which makes blood pressure rise and your heart work harder.

What to eat? You need to know the wrong stuff (fats, salt, refined grains, sugary foods) and the right stuff (whole grains, vegetables and fresh fruits that provide the most nutrition per calorie; carbs that have been minimally processed or that contain fiber). If you can't resist fast food, avoid meals labeled "giant" and "jumbo"; instead choose "child portion." To add flavor, learn which sauces and condiments are less fattening, e.g., mustard vs. mayonnaise. And remember, the calories you sip add more weight than the calories you eat. Soft drinks are Americans' single biggest source of calories, "empty calories" without any nutritional value.

Changing bad eating habits can be hard at first — especially when what's bad for you is usually cheap, convenient and tasty. Calorie for calorie, unhealthy foods cost less than healthier ones — whether a fast food chain's burgers or prepackaged supermarket fare you heat up at home. The Big Apple, despite the nickname, isn't a hub of affordable fresh produce, especially in some poorer neighborhoods where diabetes takes its highest toll.

But efforts by the city, state and community groups are introducing farmers' markets and food co-ops to supplement meager, wilted selections at some small groceries. Many takeout shops that quickly deliver to your door also have been pressured to start introducing healthier choices like salads, grilled chicken or pizza with various vegetable toppings. New York was the first city in the nation to ban artery-clogging trans fats at most restaurants and now has issued guidelines for posting calorie content on menus of fast-food eateries and major restaurant chains. It was among the first cities to ban smoking. New York also battles diabetes via free screenings, increased attention to early diabetes detection in clinical visits, and monitoring ongoing patient care. Mayor Bloomberg, along with Health Commissioner Dr. Thomas R. Frieden, recently announced that the city has 300,000 fewer smokers than in 2002 (when the ban on smoking in all workplaces was proposed) and that 364,000 more New Yorkers now have a regular doctor.

Gov. David Paterson, in his 2009 State of the State address, announced a five-point plan including the Healthy Food/Healthy Communities Initiative, which offers a new revolving loan fund to increase the number of healthy food markets in under-served neighborhoods. "We must also ban trans fats in restaurants, require calorie posting in chain restaurants, ban junk food sales in schools and place a surcharge on sugared beverages like soda," he said. In March, he agreed to scrap the so-called "fat tax" on nondiet soda, thanks to the state's infusion of stimulus money. But two major drink brands, Snapple and Pepsi, reportedly are about to start offering beverages with sugar instead of controversial high-fructose corn syrup, a synthetic sugar that some scientists say the body can't convert into a real sugar.

Mongiello says the two sweeteners have the same amount of calories but the high-fructose variety, a cheaper ingredient, is in so many foods and drinks that people unknowingly consume a lot of it.

Assessing the CUNY Campaign Against Diabetes so far, co-founder Freudenberg said there's been so much interest on campuses that the University will experiment with best times of day to offer the courses and maybe put some online. He also said he was "pleasantly surprised at how much student support there is for changing foods in the cafeterias," and that he would like to see students put pressure on the various food vendors to serve healthy foods they request. He would like to see University cafeterias post calorie counts at least for some foods, as well.

Overall, Freudenberg is looking at the bigger picture. "What we learn in this attack on diabetes, we hope will also help with the next big health concern that comes along," he said.