1
00:00:06,835 --> 00:00:09,938
>> GOOD AFTERNOON, I'M
ELISEO

2
00:00:09,938 --> 00:00:10,538
STABLE-PEREZ, DIRECTOR OF THE

3
00:00:10,538 --> 00:00:11,139
NATIONAL INSTITUTE ON MINORITY

4
00:00:11,139 --> 00:00:11,773
HEALTH AND HEALTH DISPARITIES.

5
00:00:11,773 --> 00:00:15,076
I WANT TO THANK YOU FOR JOINING

6
00:00:15,076 --> 00:00:19,247
US FOR OUR FIRST NIMHD

7
00:00:19,247 --> 00:00:20,949
DIRECTOR'S SEMINAR SERIES FOR

8
00:00:20,949 --> 00:00:21,316
2024.

9
00:00:21,316 --> 00:00:23,051
HAPPY LEAP DAY AS WELL.

10
00:00:23,051 --> 00:00:25,787
BLACK HISTORY MONTH DRAWS TO A

11
00:00:25,787 --> 00:00:26,988
CLOSE THIS LEAP YEAR, I WANT US

12
00:00:26,988 --> 00:00:29,924
TO TAKE A MOMENT TO RECOGNIZE

13
00:00:29,924 --> 00:00:31,693
SCIENTIFIC PUBLIC HEALTH LEADERS

14
00:00:31,693 --> 00:00:33,228
FROM THE BLACK AND AFRICAN

15
00:00:33,228 --> 00:00:34,963
AMERICAN COMMUNITY IN OUR

16
00:00:34,963 --> 00:00:36,398
COUNTRY'S HISTORY, FROM OUR

17
00:00:36,398 --> 00:00:39,234
PAST, OUR PRESENT, AND HOPEFULLY

18
00:00:39,234 --> 00:00:40,902
OUR FUTURE WHO MADE INDELIBLE

19
00:00:40,902 --> 00:00:42,670
IMPACT ON OUR NATION AND INDEED

20
00:00:42,670 --> 00:00:44,205
AROUND THE WORLD.

21
00:00:44,205 --> 00:00:46,274
WE PAY TRIBUTE TO THE BLACK AND

22
00:00:46,274 --> 00:00:48,009
AFRICAN AMERICAN TRAILBLAZERS IN

23
00:00:48,009 --> 00:00:49,110
CLINICAL AND HEALTH SERVICES

24
00:00:49,110 --> 00:00:50,745
RESEARCH WHO ARE COMMITTED TO

25
00:00:50,745 --> 00:00:54,249
SHAPING A BETTER AND MORE

26
00:00:54,249 --> 00:00:55,984
EQUITABLE FUTURE FOR UNDERSERVED

27
00:00:55,984 --> 00:00:57,085
AND UNDERREPRESENTED

28
00:00:57,085 --> 00:00:57,385
COMMUNITIES.

29
00:00:57,385 --> 00:00:58,186
IN HONOR OF BLACK HISTORY MONTH

30
00:00:58,186 --> 00:01:01,956
IT IS MY PLEASURE TO INTRODUCE

31
00:01:01,956 --> 00:01:04,659
DR. KENRIK DURU, AN EXPERT IN

32
00:01:04,659 --> 00:01:08,463
HEALTH DISPARITIES RESEARCH AS

33
00:01:08,463 --> 00:01:09,330
TODAY'S GUEST LECTURER, KENRIK

34
00:01:09,330 --> 00:01:11,099
WILL PRESENT ON DISPARITIES IN

35
00:01:11,099 --> 00:01:11,866
DIABETES SCREENING AND

36
00:01:11,866 --> 00:01:14,602
PREVENTION BY RACE AND

37
00:01:14,602 --> 00:01:14,903
ETHNICITY.

38
00:01:14,903 --> 00:01:18,106
DR. DURU IS A PRACTICING PRIMARY

39
00:01:18,106 --> 00:01:19,974
CARE PHYSICIAN, PROFESSOR OF

40
00:01:19,974 --> 00:01:22,677
MEDICINE AT THE UCLA MEDICAL

41
00:01:22,677 --> 00:01:23,578
SCHOOL.

42
00:01:23,578 --> 00:01:29,918
HE ACTUALLY WENT TO UCSF FOR HIS

43
00:01:29,918 --> 00:01:30,952
DOCTOR OF MEDICINE DEGREE AND

44
00:01:30,952 --> 00:01:36,257
WENT TO UCLA TO DO RESIDENCY AND

45
00:01:36,257 --> 00:01:37,559
FELLOWSHIP, OBTAINED MASTER OF

46
00:01:37,559 --> 00:01:38,993
SCIENCE IN HEALTH SERVICES FROM

47
00:01:38,993 --> 00:01:41,396
UCLA SCHOOL OF PUBLIC HEALTH.

48
00:01:41,396 --> 00:01:46,334
THAT IS WHERE I FIRST MET 

49
00:01:46,334 --> 00:01:48,536
KENRIK, AS AN INVESTIGATOR

50
00:01:48,536 --> 00:01:50,371
SCHOLAR AWARDED A PILOT GRANT

51
00:01:50,371 --> 00:01:51,372
THROUGH THE UCLA RESEARCH

52
00:01:51,372 --> 00:01:54,676
CENTERS FOR MINORITY AGING

53
00:01:54,676 --> 00:01:55,643
RESEARCH, COLLABORATORS OF OURS.

54
00:01:55,643 --> 00:01:58,279
WE HAD ONE OF THOSE CENTERS AT

55
00:01:58,279 --> 00:02:00,782
UCSF, AND THERE WAS ONE AT UCLA

56
00:02:00,782 --> 00:02:01,783
AS WELL.

57
00:02:01,783 --> 00:02:03,284
HIS RESEARCH INTERESTS INCLUDE

58
00:02:03,284 --> 00:02:05,253
ENHANCING PHYSICAL ACTIVITY

59
00:02:05,253 --> 00:02:07,222
AMONG OLDER ADULTS FROM RACIAL

60
00:02:07,222 --> 00:02:08,857
AND ETHNIC MINORITY POPULATIONS,

61
00:02:08,857 --> 00:02:10,191
DESIGNING INTERVENTIONS TO

62
00:02:10,191 --> 00:02:13,261
REDUCE DISPARITIES IN MEDICATION

63
00:02:13,261 --> 00:02:14,696
ADHERENCE, AND CLINICAL OUTCOMES

64
00:02:14,696 --> 00:02:17,198
AMONG PATIENTS WITH DIABETES.

65
00:02:17,198 --> 00:02:20,268
KENRIK LEADS RESEARCH ON HEALTH

66
00:02:20,268 --> 00:02:21,035
CARE DISPARITIES, FOR BOTH

67
00:02:21,035 --> 00:02:23,004
RACIAL AND ETHNIC MINORITY

68
00:02:23,004 --> 00:02:25,306
POPULATIONS AND PEOPLE FROM

69
00:02:25,306 --> 00:02:27,375
LOWER SOCIOECONOMIC STATUS.

70
00:02:27,375 --> 00:02:28,376
STUDIES BARRIERS AND

71
00:02:28,376 --> 00:02:29,777
FACILITATORS OF ADHERENCE TO

72
00:02:29,777 --> 00:02:33,615
MEDICINES FOR CHRONIC CONDITIONS

73
00:02:33,615 --> 00:02:34,916
OF WHICH HYPERTENSION AND

74
00:02:34,916 --> 00:02:36,818
DIABETES ARE UP THERE.

75
00:02:36,818 --> 00:02:39,988
HE HAS AN ENDURING COMMITMENT TO

76
00:02:39,988 --> 00:02:42,090
MENTORING, WORKED WITH MANY

77
00:02:42,090 --> 00:02:43,057
UNDERREPRESENTED SCHOLARS IN

78
00:02:43,057 --> 00:02:43,324
MEDICINE.

79
00:02:43,324 --> 00:02:45,226
HE IS THE PRINCIPAL INVESTIGATOR

80
00:02:45,226 --> 00:02:47,295
ON SEVERAL NIH CAREER

81
00:02:47,295 --> 00:02:48,329
DEVELOPMENT AND MENTORING

82
00:02:48,329 --> 00:02:49,297
GRANTS.

83
00:02:49,297 --> 00:02:51,266
HE HAS PUBLISHED MORE THAN 100

84
00:02:51,266 --> 00:02:52,901
PEER REVIEWED PAPERS, RECEIVED

85
00:02:52,901 --> 00:02:54,102
SEVERAL AWARDS INCLUDING

86
00:02:54,102 --> 00:02:55,270
METROPOLITAN LIFE FOUNDATION

87
00:02:55,270 --> 00:02:58,173
AWARD FOR ACADEMIC EXCELLENCE IN

88
00:02:58,173 --> 00:03:01,242
MEDICINE, WILLIAM OSLER AWARD

89
00:03:01,242 --> 00:03:02,544
FOR EXCELLENCE IN CLINICAL

90
00:03:02,544 --> 00:03:03,044
TEACHING.

91
00:03:03,044 --> 00:03:06,814
PLEASE JOIN ME IN GIVING A

92
00:03:06,814 --> 00:03:08,016
VIRTUAL WELCOME TO OUR BLACK

93
00:03:08,016 --> 00:03:13,721
HISTORY MONTH SPEAKER, DR. 

94
00:03:13,721 --> 00:03:14,489
KENRIK DURU.

95
00:03:14,489 --> 00:03:15,890
>> THANK YOU FOR THE
INVITATION.

96
00:03:15,890 --> 00:03:17,759
WE MET EACH OTHER A WHILE AGO

97
00:03:17,759 --> 00:03:19,961
BUT I ALWAYS APPRECIATED YOUR

98
00:03:19,961 --> 00:03:21,296
THOUGHTS AND INSIGHTS ON MY WORK

99
00:03:21,296 --> 00:03:22,497
AND CAREER.

100
00:03:22,497 --> 00:03:24,432
IT'S AN HONOR TO BE HERE,

101
00:03:24,432 --> 00:03:27,202
PARTICULARLY AS A BLACK MAN AND

102
00:03:27,202 --> 00:03:27,735
BLACK PHYSICIAN-SCIENTIST

103
00:03:27,735 --> 00:03:28,503
SPEAKING DURING BLACK HISTORY

104
00:03:28,503 --> 00:03:29,771
MONTH IS PARTICULARLY SPECIAL.

105
00:03:29,771 --> 00:03:31,906
I THINK WHAT I'LL BE TALKING

106
00:03:31,906 --> 00:03:33,875
ABOUT IS RELEVANT TO THE WORK I

107
00:03:33,875 --> 00:03:35,043
DO, BUT THEY IMPORTANT NOT ONLY

108
00:03:35,043 --> 00:03:37,045
FOR BLACK PEOPLE IN THIS COUNTRY

109
00:03:37,045 --> 00:03:39,013
AND AROUND THE WORLD BUT ALSO

110
00:03:39,013 --> 00:03:40,748
PEOPLE FROM OTHER GROUPS OF

111
00:03:40,748 --> 00:03:40,982
COLOR.

112
00:03:40,982 --> 00:03:43,184
AND SO WITH THAT I WILL SHARE MY

113
00:03:43,184 --> 00:03:46,120
SCREEN AND JUMP IN.

114
00:03:46,120 --> 00:03:53,127
 

115
00:03:53,127 --> 00:03:55,730
CAN YOU SEE MY SCREEN?

116
00:03:55,730 --> 00:03:57,065
YES, OKAY, TERRIFIC.

117
00:03:57,065 --> 00:03:57,332
ALL RIGHT.

118
00:03:57,332 --> 00:04:00,268
SO TODAY'S TALK WILL BE ON

119
00:04:00,268 --> 00:04:03,771
DISPARITIES IN DIABETES

120
00:04:03,771 --> 00:04:05,940
SCREENING AND PREVENTION BY RACE

121
00:04:05,940 --> 00:04:06,741
AND ETHNICITY.

122
00:04:06,741 --> 00:04:09,644
I BELIEVE SOME SLIDES YOU WILL

123
00:04:09,644 --> 00:04:11,512
KNOW AND SOME WILL BE NEW BUT

124
00:04:11,512 --> 00:04:12,513
I'LL GIVE MY PERSPECTIVE ON THE

125
00:04:12,513 --> 00:04:15,216
FIELD AND AT THE END TALK ABOUT

126
00:04:15,216 --> 00:04:16,351
WHERE IT'S GOING, WHERE IT'S

127
00:04:16,351 --> 00:04:23,391
NEEDS TO GO WHICH WILL HOPEFULLY

128
00:04:23,391 --> 00:04:25,526
JUMP START A DISCUSSION.

129
00:04:25,526 --> 00:04:29,163
THE FIRST IS DISPARITIES IN 

130
00:04:29,163 --> 00:04:30,265
DIABETES SCREENING AND

131
00:04:30,265 --> 00:04:31,766
PREVENTION.

132
00:04:31,766 --> 00:04:32,667
I'LL TALK ABOUT HISTORICAL

133
00:04:32,667 --> 00:04:34,535
VIEWS, I'M GUESSING NOT ALL OF

134
00:04:34,535 --> 00:04:36,471
YOU WILL KNOW THAT.

135
00:04:36,471 --> 00:04:39,207
AND THEN TALK ABOUT DIABETES

136
00:04:39,207 --> 00:04:40,208
PHYSIOLOGY, SUCH A COMPLEX

137
00:04:40,208 --> 00:04:41,075
DISEASE.

138
00:04:41,075 --> 00:04:43,711
SO WE'LL TALK ABOUT THE RELATIVE

139
00:04:43,711 --> 00:04:45,246
ROLES OF GENETICS VERSUS SOCIAL

140
00:04:45,246 --> 00:04:45,913
DETERMINANTS AND YOU'LL SEE

141
00:04:45,913 --> 00:04:47,982
WHERE I COME OUT ON THAT DEBATE.

142
00:04:47,982 --> 00:04:50,285
I'LL TALK A FAIR AMOUNT ABOUT

143
00:04:50,285 --> 00:04:51,919
THE DIABETES PREVENTION PROGRAM,

144
00:04:51,919 --> 00:04:53,221
THE LINCHPIN OF DIABETES

145
00:04:53,221 --> 00:04:54,222
PREVENTION IN THIS COUNTRY.

146
00:04:54,222 --> 00:04:56,391
I WANT TO MAKE SURE EVERYONE

147
00:04:56,391 --> 00:04:58,960
KNOWS ABOUT THE RCT AND EFFORTS

148
00:04:58,960 --> 00:05:00,361
TO TRANSLATE IT SUBSEQUENT.

149
00:05:00,361 --> 00:05:01,996
I'LL TALK ABOUT DIABETES

150
00:05:01,996 --> 00:05:03,531
SCREENING GUIDELINES, AND THEN

151
00:05:03,531 --> 00:05:05,066
DISPARITIES IN DIABETES

152
00:05:05,066 --> 00:05:06,434
SCREENING AND PREVENTION, AND

153
00:05:06,434 --> 00:05:08,136
THEN AS NOTED SOME NEXT STEPS WE

154
00:05:08,136 --> 00:05:12,840
CAN TAKE AS  AS A SOCIETY AND A

155
00:05:12,840 --> 00:05:15,243
HEALTH SYSTEM.

156
00:05:15,243 --> 00:05:16,778
WE PROBABLY ALL KNOW DIABETES

157
00:05:16,778 --> 00:05:18,112
PREVALENCE IS HIGH AND

158
00:05:18,112 --> 00:05:20,615
INCREASING, AS YOU SEE ON THE

159
00:05:20,615 --> 00:05:22,150
LEFT A CDC STATISTIC FROM A

160
00:05:22,150 --> 00:05:22,984
COUPLE YEARS AGO.

161
00:05:22,984 --> 00:05:25,253
WE BELIEVE 38 MILLION AMERICANS

162
00:05:25,253 --> 00:05:27,522
HAVE DIABETES, AND 1 IN 5 DON'T

163
00:05:27,522 --> 00:05:27,822
KNOW THIS.

164
00:05:27,822 --> 00:05:31,993
ON THE RIGHT YOU'LL SEE A CURVE

165
00:05:31,993 --> 00:05:34,162
THAT IS GOING UNCEASINGLY

166
00:05:34,162 --> 00:05:35,930
UPWARD, WORLDWIDE ESTIMATES FROM

167
00:05:35,930 --> 00:05:37,999
THE IDF ATLAS OF PATIENTS WITH

168
00:05:37,999 --> 00:05:38,866
DIABETES, THESE NUMBERS ARE IN

169
00:05:38,866 --> 00:05:39,867
THE MILLIONS.

170
00:05:39,867 --> 00:05:43,304
AS YOU CAN SEE IN 2000 IT WAS

171
00:05:43,304 --> 00:05:45,106
ESTIMATED THERE WERE 150 MILLION

172
00:05:45,106 --> 00:05:47,842
PEOPLE ON EARTH WITH DIABETES.

173
00:05:47,842 --> 00:05:49,477
THAT NUMBER DOUBLED AROUND 2010

174
00:05:49,477 --> 00:05:50,144
TO 300.

175
00:05:50,144 --> 00:05:53,981
IS GOING TO DOUBLE AGAIN TO 600

176
00:05:53,981 --> 00:05:55,850
MILLION SOMETIME AFTER 2030.

177
00:05:55,850 --> 00:05:57,819
WE'VE BEEN VERY UNSUCCESSFUL IN

178
00:05:57,819 --> 00:05:59,554
BENDING THE CURVE WHICH

179
00:05:59,554 --> 00:06:01,522
CONTINUES TO GO UPWARD EVERY

180
00:06:01,522 --> 00:06:02,056
YEAR.

181
00:06:02,056 --> 00:06:04,826
AND THIS IS A PROBLEM BECAUSE OF

182
00:06:04,826 --> 00:06:06,127
THE NUMEROUS KNOWN COMPLICATIONS

183
00:06:06,127 --> 00:06:09,063
OF DIABETES THAT WE SEE, AS

184
00:06:09,063 --> 00:06:10,164
ELISEO MENTIONED I SEE PATIENTS

185
00:06:10,164 --> 00:06:13,701
MUCH MORE  AND SEE THESE THINGS

186
00:06:13,701 --> 00:06:16,304
MUCH MORE THAN I WOULD LIKE.

187
00:06:16,304 --> 00:06:21,442
ON THE LEFT ARE MICROVASCULAR

188
00:06:21,442 --> 00:06:23,211
COMPLICATIONS, CHANGES IN SMALL

189
00:06:23,211 --> 00:06:24,512
VESSELS SPECIFICALLY

190
00:06:24,512 --> 00:06:25,046
CAPILLARIES.

191
00:06:25,046 --> 00:06:26,714
THESE INCLUDE CHRONIC KIDNEY

192
00:06:26,714 --> 00:06:28,349
DISEASE WHICH CAN LEAD TO

193
00:06:28,349 --> 00:06:29,550
DIALYSIS, INCLUDING FOOT

194
00:06:29,550 --> 00:06:31,319
PROBLEMS SUCH AS ULCERS AND

195
00:06:31,319 --> 00:06:33,621
NEUROPATHY THAT CAN LEAD TO

196
00:06:33,621 --> 00:06:36,124
AMPUTATIONS, AND EYE DAMAGE THAT

197
00:06:36,124 --> 00:06:37,258
CAN LEAD TO BLINDNESS.

198
00:06:37,258 --> 00:06:41,529
ON THE RIGHT ARE THE MACRO

199
00:06:41,529 --> 00:06:42,497
VASCULAR COMPLICATIONS MEDIATED

200
00:06:42,497 --> 00:06:45,233
THROUGH LARGE VESSELS INCLUDING

201
00:06:45,233 --> 00:06:46,734
ARTERIES.

202
00:06:46,734 --> 00:06:47,869
HEART ATTACK, MYOCARDIAL

203
00:06:47,869 --> 00:06:50,171
INFARCTION, CHEST PAIN, CORONARY

204
00:06:50,171 --> 00:06:52,240
HEART DISEASE, CONGESTIVE HEART

205
00:06:52,240 --> 00:06:53,007
FAILURE, AND STOKE.

206
00:06:53,007 --> 00:06:56,210
THESE ARE THE ONES WE LEARNED IN

207
00:06:56,210 --> 00:07:01,883
MED SCHOOL BUT SOME ARE 

208
00:07:01,883 --> 00:07:02,950
EMERGING OVER TIME.

209
00:07:02,950 --> 00:07:04,619
THERE ARE QUITE A FEW CANCERS

210
00:07:04,619 --> 00:07:06,187
LINKED TO DIABETES BUT EVIDENCE

211
00:07:06,187 --> 00:07:08,122
IS STRONGEST FOR THESE TWO.

212
00:07:08,122 --> 00:07:09,190
WE BELIEVE DIABETES ACTUALLY

213
00:07:09,190 --> 00:07:11,726
LEADS TO INCREASED RATES OF

214
00:07:11,726 --> 00:07:14,028
PANCREATIC CANCER, AS WELL AS

215
00:07:14,028 --> 00:07:15,563
HEPATOCELLULAR CANCER.

216
00:07:15,563 --> 00:07:16,431
WE LEARNED QUICKLY IN 2020

217
00:07:16,431 --> 00:07:19,400
DIABETES IS A RISK FACTOR FOR

218
00:07:19,400 --> 00:07:20,234
SEVERE COVID-19 INFECTION, THE

219
00:07:20,234 --> 00:07:21,903
KIND THAT PUTS YOU IN THE

220
00:07:21,903 --> 00:07:24,939
HOSPITAL OR THE ICU OR LEADS TO

221
00:07:24,939 --> 00:07:25,273
MORTALITY.

222
00:07:25,273 --> 00:07:28,509
WE ALSO KNOW DIABETES IS A

223
00:07:28,509 --> 00:07:29,811
PREDICTOR OF MAJOR DEPRESSION,

224
00:07:29,811 --> 00:07:30,912
NOT SURPRISING.

225
00:07:30,912 --> 00:07:33,214
DIABETES IS AN INDEPENDENT RISK

226
00:07:33,214 --> 00:07:34,282
FACTOR FOR DEMENTIA,

227
00:07:34,282 --> 00:07:36,150
PARTICULARLY VASCULAR DEMENTIA.

228
00:07:36,150 --> 00:07:44,926
AND DIABETES IN AND OF ITSELF 

229
00:07:44,926 --> 00:07:46,227
CAUSES SKELETAL MUSCLE ATROPHY.

230
00:07:46,227 --> 00:07:48,496
YOU'LL HEAR ABOUT THE MERITS OF

231
00:07:48,496 --> 00:07:48,796
PREVENTION.

232
00:07:48,796 --> 00:07:50,264
PEOPLE SAY IF THE PERSON IS 70

233
00:07:50,264 --> 00:07:51,899
OR 75 THEY WON'T LIVE LONG

234
00:07:51,899 --> 00:07:53,334
ENOUGH TO HAVE THOSE

235
00:07:53,334 --> 00:07:58,473
COMPLICATIONS,  DIALYSIS AND

236
00:07:58,473 --> 00:08:00,241
RETINOPATHY BUT WILL DEVELOP

237
00:08:00,241 --> 00:08:02,443
MUSCLE ATROPHY, YOU ARE NOT ABLE

238
00:08:02,443 --> 00:08:04,512
TO LIFT THINGS, PULL THINGS, DO

239
00:08:04,512 --> 00:08:06,380
THE THINGS YOU NEED TO DO, THIS

240
00:08:06,380 --> 00:08:08,115
IS ONE CONTRIBUTOR TO LOSS OF

241
00:08:08,115 --> 00:08:08,616
INDEPENDENCE.

242
00:08:08,616 --> 00:08:10,318
SO I'M A BIG BELIEVER IN TRYING

243
00:08:10,318 --> 00:08:13,387
TO PREVENT DIABETES THE BEST WE

244
00:08:13,387 --> 00:08:16,257
CAN FROM CHILDHOOD THROUGH OLDER

245
00:08:16,257 --> 00:08:19,660
ADULTHOOD.

246
00:08:19,660 --> 00:08:22,497
SO, THIS IS EVIDENCE FROM 2019

247
00:08:22,497 --> 00:08:23,364
JAMA PAPER.

248
00:08:23,364 --> 00:08:24,265
WHATEVER NON-WHITE GROUP YOU

249
00:08:24,265 --> 00:08:25,566
LOOK AT THEY HAVE HIGHER

250
00:08:25,566 --> 00:08:26,501
PREVALENCE OF DIABETES.

251
00:08:26,501 --> 00:08:30,238
THIS IS THE PREVALENCE IN THE

252
00:08:30,238 --> 00:08:33,007
U.S., DIAGNOSED AND UNDIAGNOSED,

253
00:08:33,007 --> 00:08:34,509
20+ YEARS AGE, VERTICAL BAR ON

254
00:08:34,509 --> 00:08:36,711
THE FAR LEFT IS NON-HISPANIC

255
00:08:36,711 --> 00:08:37,178
WHITES.

256
00:08:37,178 --> 00:08:38,779
EVERY OTHER BAR ON THIS GRAPH IS

257
00:08:38,779 --> 00:08:41,616
HIGHER THAN THAT FOR

258
00:08:41,616 --> 00:08:44,151
NON-HISPANIC WHITES.

259
00:08:44,151 --> 00:08:47,388
NON-HISPANIC BLACKS, MEXICAN

260
00:08:47,388 --> 00:08:49,957
AMERICAN, PUERTO RICAN

261
00:08:49,957 --> 00:08:50,825
AMERICANS, CUBAN, DOMINICAN,

262
00:08:50,825 --> 00:08:52,059
CENTRAL AND SOUTH AMERICAN, AND

263
00:08:52,059 --> 00:08:54,762
THREE COLUMNS ON THE RIGHT,

264
00:08:54,762 --> 00:08:56,931
HIGHER THAN WHITES AMONG EAST

265
00:08:56,931 --> 00:08:59,333
ASIAN INDIVIDUALS, SOUTH ASIAN

266
00:08:59,333 --> 00:09:03,604
INDIVIDUALS, AND SOUTHEAST ASIAN

267
00:09:03,604 --> 00:09:04,572
INDIVIDUALS.

268
00:09:04,572 --> 00:09:05,373
AND THESE ARE COMPLICATIONS, THE

269
00:09:05,373 --> 00:09:07,675
DATA IS OLD BUT THE POINTS ARE

270
00:09:07,675 --> 00:09:10,511
THE MAIN THING THAT STILL HOLD.

271
00:09:10,511 --> 00:09:11,946
THE SECOND COLUMN, THIS BY IS

272
00:09:11,946 --> 00:09:14,649
THE WAY IS END STAGE RENAL

273
00:09:14,649 --> 00:09:17,585
DISEASE DUE TO DIABETES, LEVEL

274
00:09:17,585 --> 00:09:20,054
FOR WHITE PATIENTS, MUCH HIGHER

275
00:09:20,054 --> 00:09:29,797
FOR AFRICAN AMERICAN, NATIVE

276
00:09:29,797 --> 00:09:30,665
NATIVE AMERICAN AND ASIAN,

277
00:09:30,665 --> 00:09:31,899
ACROSS THE BOARD.

278
00:09:31,899 --> 00:09:32,867
AMPUTATIONS, THIS IS L.A., IF

279
00:09:32,867 --> 00:09:34,068
YOU DIDN'T KNOW YOU CAN SEE THE

280
00:09:34,068 --> 00:09:35,069
FREEWAYS ON THERE.

281
00:09:35,069 --> 00:09:36,571
OME ONE PLACE HAS THIS MANY,

282
00:09:36,571 --> 00:09:40,007
THAT WOULD BE LOS ANGELES.

283
00:09:40,007 --> 00:09:42,843
ON THIS GRAPH, ON THIS MAP

284
00:09:42,843 --> 00:09:44,278
RATHER, DARKER COLORS INDICATE

285
00:09:44,278 --> 00:09:45,580
HIGHER RATE OF AMPUTATIONS.

286
00:09:45,580 --> 00:09:47,114
AND ON THE SOUTH CENTRAL PART OF

287
00:09:47,114 --> 00:09:48,549
THE SLIDE TOWARDS THE BOTTOM

288
00:09:48,549 --> 00:09:51,285
THAT'S SOUTH CENTRAL LOS

289
00:09:51,285 --> 00:09:52,820
ANGELES, WHICH IS PREDOMINANTLY

290
00:09:52,820 --> 00:09:54,555
LATINO AND BLACK AREA.

291
00:09:54,555 --> 00:09:57,224
YOU'LL SEE IN THE MIDDLE TOWARDS

292
00:09:57,224 --> 00:09:59,293
THE NORTH IS SAN FERNANDO

293
00:09:59,293 --> 00:10:00,494
VALLEY, PRIMARILY LATINO AREA,

294
00:10:00,494 --> 00:10:03,364
AND THOSE AREAS HAVE REALLY HIGH

295
00:10:03,364 --> 00:10:04,565
RATES OF AMPUTATIONS.

296
00:10:04,565 --> 00:10:06,867
THE BIG WHITE AREA TO THE LEFT

297
00:10:06,867 --> 00:10:07,735
IS PACIFIC OCEAN.

298
00:10:07,735 --> 00:10:09,604
IF YOU LOOK AT COASTAL

299
00:10:09,604 --> 00:10:11,706
COMMUNITIES, IT'S NOT LABELED

300
00:10:11,706 --> 00:10:14,141
BUT CERTAINLY SANTA BARBARA,

301
00:10:14,141 --> 00:10:19,580
MALIBU, PACIFIC PALISADES, SANTA

302
00:10:19,580 --> 00:10:23,050
MONICA, MANHATTAN BEACH, RANCHO

303
00:10:23,050 --> 00:10:23,918
PALOS VERDES WHERE AMPUTATIONS

304
00:10:23,918 --> 00:10:26,687
ARE LOWEST, IT COULD BE

305
00:10:26,687 --> 00:10:28,155
SUPERIMPOSED BY RACE/ETHNICITY,

306
00:10:28,155 --> 00:10:29,657
IT'S ESSENTIALLY SHOWING THE

307
00:10:29,657 --> 00:10:30,758
SAME THING.

308
00:10:30,758 --> 00:10:33,060
JUST A SLIDE ON EYE DISEASE, I

309
00:10:33,060 --> 00:10:33,928
MENTIONED THE MAIN TAKEHOME

310
00:10:33,928 --> 00:10:36,564
POINT IS THE GREEN BARS FOR

311
00:10:36,564 --> 00:10:38,165
HISPANIC LATINO PATIENTS, WHO

312
00:10:38,165 --> 00:10:40,201
STARTING AT AGE 50 CERTAINLY

313
00:10:40,201 --> 00:10:46,974
HAVE HIGHER RATES OF  

314
00:10:46,974 --> 00:10:49,744
RETINOPATHY THAN WHITE OR EVEN

315
00:10:49,744 --> 00:10:50,378
BLACK PATIENTS.

316
00:10:50,378 --> 00:10:52,546
DIABETES IS NOT ONLY MORE COMMON

317
00:10:52,546 --> 00:10:54,315
AMONG PERSONS OF COLOR BUT THE

318
00:10:54,315 --> 00:10:55,716
COMPLICATIONS ARE ALSO MORE

319
00:10:55,716 --> 00:10:57,918
COMMON IN THIS GROUP.

320
00:10:57,918 --> 00:11:02,757
SO I AM GENERATION X.

321
00:11:02,757 --> 00:11:06,027
THIS IS FROM THE ROCKY AND

322
00:11:06,027 --> 00:11:06,794
BULLWINKLE SHOW, THE WAYBACK

323
00:11:06,794 --> 00:11:07,194
MACHINE.

324
00:11:07,194 --> 00:11:09,463
THE DOG WITH THE BOW TIE IS

325
00:11:09,463 --> 00:11:11,098
MR. PEABODY, THE BOY IS SHERMAN.

326
00:11:11,098 --> 00:11:12,500
THEY USED TO GO BACK AND TAKE

327
00:11:12,500 --> 00:11:14,368
KIDS BACK TO LEARN ABOUT

328
00:11:14,368 --> 00:11:14,602
HISTORY.

329
00:11:14,602 --> 00:11:16,437
I WATCHED THIS MANY A SATURDAY

330
00:11:16,437 --> 00:11:16,671
MORNING.

331
00:11:16,671 --> 00:11:18,205
SO WE'RE GOING TO DO THAT NOW,

332
00:11:18,205 --> 00:11:20,374
GO IN THE WAYBACK MACHINE TO

333
00:11:20,374 --> 00:11:22,677
THINK ABOUT DIABETES AND RACE,

334
00:11:22,677 --> 00:11:23,544
130 YEARS AGO.

335
00:11:23,544 --> 00:11:25,846
IN FACT WE'RE GOING TO 1898 AND

336
00:11:25,846 --> 00:11:28,382
SEE WHAT THE SITUATION WAS.

337
00:11:28,382 --> 00:11:29,784
THESE ARE THE VIEWS THAT WERE

338
00:11:29,784 --> 00:11:31,318
OUT THERE THEN.

339
00:11:31,318 --> 00:11:34,588
SO IN 1898, IT WAS NOTED THAT

340
00:11:34,588 --> 00:11:36,023
DIABETES IS RARE IN THE COLORED

341
00:11:36,023 --> 00:11:37,358
RACE, THOSE ARE PEOPLE THAT NOW

342
00:11:37,358 --> 00:11:39,927
WE WOULD REFER TO AS BLACK OF

343
00:11:39,927 --> 00:11:40,161
COURSE.

344
00:11:40,161 --> 00:11:42,563
IN 1913 IT WAS NOTED DIABETES IS

345
00:11:42,563 --> 00:11:46,767
2 1/2 TIMES AS COMMON AMONG JEWS

346
00:11:46,767 --> 00:11:47,968
THAN NON-JEWS.

347
00:11:47,968 --> 00:11:52,239
THINGS WERE CHANGING IN THIS

348
00:11:52,239 --> 00:11:52,606
COUNTRY.

349
00:11:52,606 --> 00:11:53,774
BY 1950s DISCOVERY WAS MADE

350
00:11:53,774 --> 00:11:55,843
PIMA INDIANS HAVE THE HIGHEST

351
00:11:55,843 --> 00:12:01,982
DIABETES RATE IN THE WORLD,

352
00:12:01,982 --> 00:12:02,216
UNQUOTE.

353
00:12:02,216 --> 00:12:04,185
IN 1980s, MEXICAN AMERICANS

354
00:12:04,185 --> 00:12:05,553
ARE A DIABETIC RACE,

355
00:12:05,553 --> 00:12:05,886
QUOTE/UNQUOTE.

356
00:12:05,886 --> 00:12:07,922
YOU CAN SEE A LOT OF CHANGES

357
00:12:07,922 --> 00:12:10,324
HERE FROM THE BEGINNING, THE END

358
00:12:10,324 --> 00:12:12,093
RATHER, 19th CENTURY THROUGH

359
00:12:12,093 --> 00:12:13,160
END OF 20th CENTURY.

360
00:12:13,160 --> 00:12:15,362
AND JUST A NOTE WHILE WE'RE

361
00:12:15,362 --> 00:12:17,198
TALKING ABOUT THIS, DISPARITIES

362
00:12:17,198 --> 00:12:18,632
ARE NOT PRE-ORDAINED.

363
00:12:18,632 --> 00:12:21,035
SO, THESE ARE SOME MORE QUOTES

364
00:12:21,035 --> 00:12:22,670
REGARDING BLACK PEOPLE AND

365
00:12:22,670 --> 00:12:26,273
DIABETES, APPARENTLY SOMEONE 

366
00:12:26,273 --> 00:12:27,208
TOOK MINUTES FROM THE 1904

367
00:12:27,208 --> 00:12:28,676
AMERICAN MEDICAL ASSOCIATION

368
00:12:28,676 --> 00:12:29,210
CONVENTION.

369
00:12:29,210 --> 00:12:30,778
SOMEONE SAID I HAVE NEVER SEEN A

370
00:12:30,778 --> 00:12:32,747
CASE OF DIABETES IN A COLORED

371
00:12:32,747 --> 00:12:36,150
PATIENT AND I DO NOT KNOW OF

372
00:12:36,150 --> 00:12:37,418
ANOTHER PRACTITIONER WHO HAS.

373
00:12:37,418 --> 00:12:41,155
SOUNDS LIKE SOMEONE ELSE AGREED

374
00:12:41,155 --> 00:12:42,990
WHOLEHEARTEDLY, A SENTIMENT

375
00:12:42,990 --> 00:12:44,992
AMONG ATTENDEES IN 1904.

376
00:12:44,992 --> 00:12:47,094
YOU MIGHT THINK MAYBE THAT'S

377
00:12:47,094 --> 00:12:49,029
BECAUSE GIVEN THE JIM CROW

378
00:12:49,029 --> 00:12:50,531
RACISM OF THE DAY PEOPLE WEREN'T

379
00:12:50,531 --> 00:12:53,234
SEEING BLACK PATIENTS BUT THE

380
00:12:53,234 --> 00:12:54,769
BOTTOM QUOTE, CHARLES BURNIE WAS

381
00:12:54,769 --> 00:12:56,070
THE FIRST LICENSED BLACK

382
00:12:56,070 --> 00:12:58,272
PHYSICIAN IN SOUTH CAROLINA, HE

383
00:12:58,272 --> 00:13:01,375
GAVE THIS QUOTE IN 1910.

384
00:13:01,375 --> 00:13:02,209
ANY PHYSICIAN IN PRACTICE WITH

385
00:13:02,209 --> 00:13:03,844
COUNT ON THE END OF HIS FINGERS

386
00:13:03,844 --> 00:13:04,879
THE NUMBER OF CASES OF DIABETES

387
00:13:04,879 --> 00:13:07,348
HE HAS NOTED IN THE NEGRO RACE.

388
00:13:07,348 --> 00:13:08,983
I THINK WE CAN ASSUME GIVEN

389
00:13:08,983 --> 00:13:10,851
AGAIN THE SEGREGATION OF THE DAY

390
00:13:10,851 --> 00:13:13,721
THAT ALL OF HIS PATIENTS, ALMOST

391
00:13:13,721 --> 00:13:17,892
ALL OF HIS PATIENTS WERE BLACK,

392
00:13:17,892 --> 00:13:19,727
HE SAW VERY FEW CASES OF

393
00:13:19,727 --> 00:13:19,994
DIABETES.

394
00:13:19,994 --> 00:13:21,729
THIS IS NOT SURPRISING.

395
00:13:21,729 --> 00:13:23,130
UNFORTUNATELY IN THOSE DAYS, I

396
00:13:23,130 --> 00:13:24,331
THINK BLACK PEOPLE TOOK JOBS

397
00:13:24,331 --> 00:13:26,967
THAT NO ONE ELSE WOULD.

398
00:13:26,967 --> 00:13:28,803
THERE WAS A LOT OF AGGRESSIVE

399
00:13:28,803 --> 00:13:30,237
PHYSICAL LABOR FOR BOTH MEN AND

400
00:13:30,237 --> 00:13:31,539
FOR WOMEN.

401
00:13:31,539 --> 00:13:33,407
WE SAW VERY FEW BLACK PEOPLE

402
00:13:33,407 --> 00:13:36,510
WORKING DESK JOBS. 

403
00:13:36,510 --> 00:13:39,313
ALSO I THINK FOOD WASN'T IN

404
00:13:39,313 --> 00:13:40,714
ABUNDANCE, YOU COULDN'T EAT TO

405
00:13:40,714 --> 00:13:43,350
EXCESS ACROSS THE POPULATION SO

406
00:13:43,350 --> 00:13:46,320
NOT SURPRISING WE SAW LOWER

407
00:13:46,320 --> 00:13:47,855
RATES AMONG BLACK INDIVIDUALS

408
00:13:47,855 --> 00:13:50,057
130 YEARS AGO OF DIABETES.

409
00:13:50,057 --> 00:13:51,358
DISPARITIES ARE NOT

410
00:13:51,358 --> 00:13:51,692
PRE-ORDAINED.

411
00:13:51,692 --> 00:13:52,560
BECAUSE WE MAY HAVE SEEN

412
00:13:52,560 --> 00:13:55,930
SOMETHING ALL OUR LIFE AND YOU

413
00:13:55,930 --> 00:13:57,031
ASSUME IT'S GOSPEL, IT ISN'T

414
00:13:57,031 --> 00:13:58,032
ALWAYS THE CASE.

415
00:13:58,032 --> 00:13:59,433
THINGS WEREN'T ALL THIS WAY.

416
00:13:59,433 --> 00:14:00,334
MORE IMPORTANT, THEY MAY NOT

417
00:14:00,334 --> 00:14:02,603
ALWAYS BE I THIS IF WE CAN FIND

418
00:14:02,603 --> 00:14:07,441
THE RIGHT LEVERS TO PULL TO MAKE

419
00:14:07,441 --> 00:14:07,875
CHANGES.

420
00:14:07,875 --> 00:14:10,177
SO, ALSO INTERESTING, BY THE WAY

421
00:14:10,177 --> 00:14:12,246
CITATION AT THE BOTTOM WHERE THE

422
00:14:12,246 --> 00:14:14,648
QUOTES COME FROM, A FASCINATING

423
00:14:14,648 --> 00:14:18,385
BOOK BY TUCHMAN, A HISTORY OF

424
00:14:18,385 --> 00:14:20,888
RACE AND DISEASE.

425
00:14:20,888 --> 00:14:23,090
ANYBODY INTERESTED SHOULD READ

426
00:14:23,090 --> 00:14:24,625
THIS BOOK, ILLUMINATING TO PUT

427
00:14:24,625 --> 00:14:26,360
OUR CURRENT WORK INTO CONTEXT.

428
00:14:26,360 --> 00:14:29,096
THE BOOK NOTES THERE WAS A

429
00:14:29,096 --> 00:14:30,531
THOUGHT 100+ YEARS AGO DIABETES

430
00:14:30,531 --> 00:14:31,498
WAS A JEWISH DISEASE.

431
00:14:31,498 --> 00:14:32,299
THAT WAS THE GROUP THAT WAS

432
00:14:32,299 --> 00:14:34,668
THOUGHT TO HAVE THE HIGHEST

433
00:14:34,668 --> 00:14:39,039
RATES OF DIABETES.

434
00:14:39,039 --> 00:14:40,808
ALBERT EPSTEIN IN 1919 SAID WHEN

435
00:14:40,808 --> 00:14:42,977
THE JEW IS THIRSTY HE HAS SUGAR

436
00:14:42,977 --> 00:14:43,310
TESTED.

437
00:14:43,310 --> 00:14:46,046
WHEN THE CHRISTIAN IS THIRSTY,

438
00:14:46,046 --> 00:14:46,480
HE DRINKS.

439
00:14:46,480 --> 00:14:48,883
VERY DIFFERENT IDEAS ABOUT WHO

440
00:14:48,883 --> 00:14:50,718
HAS DIABETES.

441
00:14:50,718 --> 00:14:52,052
PEOPLE MAY KNOW JOSLIN DIABETES

442
00:14:52,052 --> 00:14:55,356
CENTER IS THE LARGEST IN THE

443
00:14:55,356 --> 00:15:00,060
WORLDN BOSTON, NAMED AFTER 

444
00:15:00,060 --> 00:15:03,130
ELLIOTT JOSLIN, WHO STATED IN

445
00:15:03,130 --> 00:15:04,331
1916 THE FREQUENCY WITH WHICH

446
00:15:04,331 --> 00:15:06,166
DIABETES OCCURS IN THE JEWISH

447
00:15:06,166 --> 00:15:07,701
RACE IS PROVERBIAL.

448
00:15:07,701 --> 00:15:08,335
SO DIFFERENT PICTURE, IF YOU

449
00:15:08,335 --> 00:15:09,470
DIALED BACK IN THE WAYBACK

450
00:15:09,470 --> 00:15:11,639
MACHINE TO WHAT PEOPLE WERE

451
00:15:11,639 --> 00:15:12,773
THINKING ABOUT DIABETES IN THE

452
00:15:12,773 --> 00:15:14,508
BEGINNING OF THE 20th CENTURY,

453
00:15:14,508 --> 00:15:16,710
JUST ANOTHER REMINDER SOMETIMES

454
00:15:16,710 --> 00:15:18,345
WE MAKE ASSUMPTIONS THAT WE

455
00:15:18,345 --> 00:15:19,079
SHOULDN'T, JUMPING TO

456
00:15:19,079 --> 00:15:19,546
CONCLUSIONS.

457
00:15:19,546 --> 00:15:22,283
I WILL SAY THESE ARE ALL

458
00:15:22,283 --> 00:15:22,650
ANECDOTES.

459
00:15:22,650 --> 00:15:24,919
THERE WASN'T GOOD NATIONAL DATA

460
00:15:24,919 --> 00:15:26,553
UNTIL 1950s, ALL WE HAVE IS

461
00:15:26,553 --> 00:15:28,222
ANECDOTES BUT SEEMS LIKE THINGS

462
00:15:28,222 --> 00:15:29,456
WERE DIFFERENT IN TERMS OF MAYBE

463
00:15:29,456 --> 00:15:31,358
WHO WAS MORE LIKELY TO HAVE

464
00:15:31,358 --> 00:15:34,161
DIABETES THAN THEY DO TODAY.

465
00:15:34,161 --> 00:15:35,696
AND THIS IS WHY.

466
00:15:35,696 --> 00:15:38,198
THIS IS LOOKING AT THE BODY MASS

467
00:15:38,198 --> 00:15:40,601
INDEX IN THIS COUNTRY, 19th

468
00:15:40,601 --> 00:15:41,435
AND 20th CENTURY.

469
00:15:41,435 --> 00:15:43,804
THIS GRAPH, THE DATA HERE IS

470
00:15:43,804 --> 00:15:44,805
FROM 18-YEAR-OLD WHITE MEN, BUT

471
00:15:44,805 --> 00:15:47,207
I THINK WE CAN SEE SIMILAR

472
00:15:47,207 --> 00:15:48,842
TRENDS OR ASSUME SIMILAR TRENDS

473
00:15:48,842 --> 00:15:51,578
IN WHITE WOMEN, AND IN BOTH MEN

474
00:15:51,578 --> 00:15:55,382
AND WOMEN OF OTHER RACIAL/ETHNIC

475
00:15:55,382 --> 00:15:55,950
GROUPS.

476
00:15:55,950 --> 00:16:01,088
X-AXIS IS BIRTH COHORT, BORN IN 

477
00:16:01,088 --> 00:16:06,427
A GIVEN YEAR, Y-AXIS IS BMI.

478
00:16:06,427 --> 00:16:09,163
YOU CAN SEE THE BMI ON AVERAGE

479
00:16:09,163 --> 00:16:11,799
WAS BELOW 20, WEST POINT CADETS.

480
00:16:11,799 --> 00:16:14,768
DATA FROM THE CITADEL, THAT 

481
00:16:14,768 --> 00:16:17,705
WOULD BE THE SECOND COLUMN, BMI

482
00:16:17,705 --> 00:16:22,977
CLOSE TO 20, BARELY ABOVE ON

483
00:16:22,977 --> 00:16:23,210
AVERAGE.

484
00:16:23,210 --> 00:16:25,612
IN THE MIDDLE, INCREASE TO 22 ON

485
00:16:25,612 --> 00:16:27,014
AVERAGE, GREATEST GENERATION.

486
00:16:27,014 --> 00:16:29,850
U.S. DATA FOR WHITE 18-YEAR-OLD

487
00:16:29,850 --> 00:16:33,153
MEN NATIONALLY AGAIN IT'S AROUND

488
00:16:33,153 --> 00:16:37,524
THAT, IN THE 50s JUMPS UP TO

489
00:16:37,524 --> 00:16:41,462
THE IN THE '80s CLOSE TO

490
00:16:41,462 --> 00:16:41,996
OVERWEIGHT.

491
00:16:41,996 --> 00:16:44,431
THE TRAJECTORY IS THE SAME,

492
00:16:44,431 --> 00:16:46,467
MAYBE SHARPER AND HIGHER FOR

493
00:16:46,467 --> 00:16:47,801
PEOPLE OF OTHER RACIAL AND

494
00:16:47,801 --> 00:16:50,871
ETHNIC GROUPS.

495
00:16:50,871 --> 00:16:51,872
WHAT HAS CHANGED, HISTORICAL

496
00:16:51,872 --> 00:16:53,273
VIEWS WE'RE LEARNING ABOUT FROM

497
00:16:53,273 --> 00:16:54,074
EARLY 20th CENTURY HAVE

498
00:16:54,074 --> 00:16:59,079
CHANGED QUITE A BIT AS WE SIT

499
00:16:59,079 --> 00:17:00,280
HERE TOGETHER IN 2024.

500
00:17:00,280 --> 00:17:02,583
ALSO, FOR THOSE WHO DON'T STUDY

501
00:17:02,583 --> 00:17:05,419
DIABETES IN GREAT DETAIL, JUST A

502
00:17:05,419 --> 00:17:06,854
REMINDER DIABETES IS AN OVERALL

503
00:17:06,854 --> 00:17:07,621
PHENOTYPE.

504
00:17:07,621 --> 00:17:09,723
IF YOU CHECKED YOUR SUGAR ON AN

505
00:17:09,723 --> 00:17:10,491
EMPTY STOMACH TWO DIFFERENT

506
00:17:10,491 --> 00:17:12,659
MORNINGS AND GOT THAT READING OF

507
00:17:12,659 --> 00:17:15,496
180, YOU WOULD HAVE DIABETES BY

508
00:17:15,496 --> 00:17:16,030
DEFINITION.

509
00:17:16,030 --> 00:17:17,698
BUT VERY LITTLE IDEA AS TO WHY,

510
00:17:17,698 --> 00:17:20,200
WHAT'S GOING ON, UNDER THE HOOD

511
00:17:20,200 --> 00:17:21,735
WITH YOU.

512
00:17:21,735 --> 00:17:23,137
THERE COULD BE MANY PHYSIOLOGIC

513
00:17:23,137 --> 00:17:24,571
PERTURBATIONS LEADING TO THE

514
00:17:24,571 --> 00:17:27,307
ELEVATED BLOOD SUGAR.

515
00:17:27,307 --> 00:17:28,742
THE TERM DIABETES MELLITUS IS A

516
00:17:28,742 --> 00:17:35,883
COMBINATION OF GREEK AND LATIN

517
00:17:35,883 --> 00:17:37,051
WORDS FOR SIPHON SPEED SWEET

518
00:17:37,051 --> 00:17:40,154
MEANING YOUR URINE IS SWEET WITH

519
00:17:40,154 --> 00:17:42,022
SUGAR, THAT'S HOW DIABETES WAS

520
00:17:42,022 --> 00:17:44,525
DIAGNOSED FOR CENTURIES, WE KNOW

521
00:17:44,525 --> 00:17:46,493
IT INCLUDES MANY PHENOTYPES AND

522
00:17:46,493 --> 00:17:47,694
IT'S A SPECTRUM.

523
00:17:47,694 --> 00:17:49,897
MANY OF US PROBABLY ARE USED TO

524
00:17:49,897 --> 00:17:51,098
THINKING ABOUT DIABETES AS TYPE

525
00:17:51,098 --> 00:17:52,633
1 VERSUS TYPE 2, THAT'S WHAT I

526
00:17:52,633 --> 00:17:54,268
WAS TAUGHT IN MED SCHOOL.

527
00:17:54,268 --> 00:17:55,702
BUT I THINK IN THIS 21ST CENTURY

528
00:17:55,702 --> 00:17:57,571
AS WE GO IT'S GOING TO BE A

529
00:17:57,571 --> 00:17:59,106
DIFFERENT PARADIGM.

530
00:17:59,106 --> 00:17:59,640
WE'LL SLOWLY CHANGE.

531
00:17:59,640 --> 00:18:01,975
I THINK WHERE WE'RE HEADED IS IN

532
00:18:01,975 --> 00:18:04,144
BOLD THERE, WE'LL BE TALKING

533
00:18:04,144 --> 00:18:07,748
ABOUT DIABETES WITH PREDOMINANT

534
00:18:07,748 --> 00:18:08,949
BETA-CELL DYSFUNCTION, THAT

535
00:18:08,949 --> 00:18:11,151
CREATE INSULIN, AND DIABETES

536
00:18:11,151 --> 00:18:12,586
WITH PREDOMINANT INSULIN

537
00:18:12,586 --> 00:18:14,455
RESISTANCE, WHERE CELLS AREN'T

538
00:18:14,455 --> 00:18:17,291
ABLE TO UPTAKE INSULIN TO HAVE

539
00:18:17,291 --> 00:18:19,359
INTENDED EFFECTS OF LOWERING

540
00:18:19,359 --> 00:18:20,627
YOUR BLOOD SUGAR LEVEL.

541
00:18:20,627 --> 00:18:21,795
THERE WILL BE A LOT OF

542
00:18:21,795 --> 00:18:22,529
CONDITIONS IN BETWEEN.

543
00:18:22,529 --> 00:18:25,432
SOME OF THOSE ARE BELOW,

544
00:18:25,432 --> 00:18:26,300
SOMETHING CALLED MONOGENIC

545
00:18:26,300 --> 00:18:28,802
DIABETES, MODY, WHICH IS RELATED

546
00:18:28,802 --> 00:18:31,371
TO DIFFERENT LIVER AND PANCREAS

547
00:18:31,371 --> 00:18:33,941
PERTURBATIONS THAT LEAD TO

548
00:18:33,941 --> 00:18:37,010
ELEVATED BLOOD SUGAR.

549
00:18:37,010 --> 00:18:40,180
THERE'S LATENT AUTOIMMUNE

550
00:18:40,180 --> 00:18:44,918
DIABETES OF ADULTHOOD, SECRETING

551
00:18:44,918 --> 00:18:49,089
LESS INSULIN, RATHER THAN THE

552
00:18:49,089 --> 00:18:50,157
SUDDEN ONSET OF TYPE 1.

553
00:18:50,157 --> 00:18:51,492
WE'RE MOVING INTO THE AREA OF

554
00:18:51,492 --> 00:18:52,493
PRECISION MEDICINE, TERRIFIC

555
00:18:52,493 --> 00:18:55,462
WHEN IT COMES TO DIABETES, TO

556
00:18:55,462 --> 00:18:56,563
BETTER UNDERSTAND EACH

557
00:18:56,563 --> 00:18:59,500
INDIVIDUAL, IDEALLY OFFER THEM

558
00:18:59,500 --> 00:19:01,135
TREATMENT THEY NEED.

559
00:19:01,135 --> 00:19:02,336
AND DIABETES PHYSIOLOGY IS

560
00:19:02,336 --> 00:19:07,040
COMPLEX LIKE I NOTED, THAT 180,

561
00:19:07,040 --> 00:19:09,109
THERE COULD BE MANY THINGS GOING

562
00:19:09,109 --> 00:19:10,244
ON.  I WOULDN'T FOCUS ON THE

563
00:19:10,244 --> 00:19:10,644
TEXT.

564
00:19:10,644 --> 00:19:14,081
THESE ARE ALL THE ORGANS AT

565
00:19:14,081 --> 00:19:16,049
INTERPLAY WITH DIABETES.

566
00:19:16,049 --> 00:19:18,452
BOTTOM LEFT IS INTESTINES, YOU

567
00:19:18,452 --> 00:19:20,521
CAN SEE THERE'S THE BRAIN, THESE

568
00:19:20,521 --> 00:19:23,056
ARE FAT CELLS, THIS IS THE

569
00:19:23,056 --> 00:19:24,358
LIVER, THIS IS MUSCLE.

570
00:19:24,358 --> 00:19:26,560
AND THIS IS THE PANCREAS.

571
00:19:26,560 --> 00:19:28,529
AND REALLY YOU COULD HAVE ISSUES

572
00:19:28,529 --> 00:19:30,497
WITH ANY OF THESE ORGANS,

573
00:19:30,497 --> 00:19:32,466
MULTIPLE ORGANS, END UP WITH THE

574
00:19:32,466 --> 00:19:33,534
SAME INSULIN RESISTANCE AT THE

575
00:19:33,534 --> 00:19:34,868
BOTTOM WHICH LEADS TO DIABETES.

576
00:19:34,868 --> 00:19:36,303
I THINK THE MAIN OTHER THING TO

577
00:19:36,303 --> 00:19:38,939
NOTE AS YOU SEE AT THE TOP

578
00:19:38,939 --> 00:19:39,806
THERE'S OBESITY, OBESITY

579
00:19:39,806 --> 00:19:41,642
DIRECTLY AFFECTS ALL OF THESE

580
00:19:41,642 --> 00:19:41,875
ORGANS.

581
00:19:41,875 --> 00:19:43,944
AND THAT IS WHAT HAS CHANGED IN

582
00:19:43,944 --> 00:19:46,914
OUR SOCIETY, THAT'S WHAT IS

583
00:19:46,914 --> 00:19:48,048
DRIVING THESE MULTIPLE DIFFERENT

584
00:19:48,048 --> 00:19:51,185
PHENOTYPES OF DIABETES IN THE 

585
00:19:51,185 --> 00:19:54,988
PATIENTS THAT WE SEE.

586
00:19:54,988 --> 00:19:56,857
SO, IN MY BELIEF, GENETICS IS

587
00:19:56,857 --> 00:20:00,194
NOT A MAJOR DRIVER OF DIABETES

588
00:20:00,194 --> 00:20:00,494
DISPARITIES.

589
00:20:00,494 --> 00:20:02,129
I THINK THERE'S A RECENT

590
00:20:02,129 --> 00:20:03,530
"NATURE" STUDY FROM LAST MONTH

591
00:20:03,530 --> 00:20:06,700
THAT LOOKED AT THE TYPE 2

592
00:20:06,700 --> 00:20:07,367
DIABETES GLOBAL GENOMICS

593
00:20:07,367 --> 00:20:13,473
INITIATIVE THAT HAD MORE THAN

594
00:20:13,473 --> 00:20:15,242
2.5 MILLION PATIENTS, DIVERSE,

595
00:20:15,242 --> 00:20:17,110
PEOPLE AROUND THE WORLD, 40%

596
00:20:17,110 --> 00:20:18,512
NON-WHITE PARTICIPANTS.

597
00:20:18,512 --> 00:20:20,280
THE AUTHORS CONDUCTED A GWAS

598
00:20:20,280 --> 00:20:23,650
ANALYSIS, IF YOU DON'T KNOW

599
00:20:23,650 --> 00:20:29,056
THAT'S A GENOME WIDE ASSOCIATION

600
00:20:29,056 --> 00:20:29,256
STUDY.

601
00:20:29,256 --> 00:20:31,992
THEY FOUND 127 SINGLE NUCLEOTIDE

602
00:20:31,992 --> 00:20:32,593
POLYMORPHISMS, GENETIC

603
00:20:32,593 --> 00:20:34,294
DIFFERENCES IN A POPULATION THAT

604
00:20:34,294 --> 00:20:38,899
IN THIS CASE PREDICT DIABETES

605
00:20:38,899 --> 00:20:44,805
AND 127  CONTINENT OF ORIGIN.

606
00:20:44,805 --> 00:20:47,541
THIS WAS ONLY 10% OF TOTAL

607
00:20:47,541 --> 00:20:58,018
NUMBER OF SNPs, HOWEVER WHEN

608
00:20:59,086 --> 00:21:01,121
YOU ADJUST FOR BMI 103 WERE NO

609
00:21:01,121 --> 00:21:02,756
LONGER SIGNIFICANT.

610
00:21:02,756 --> 00:21:04,725
81%.

611
00:21:04,725 --> 00:21:09,529
WE'RE TALKING ABOUT 20% OF 10%

612
00:21:09,529 --> 00:21:11,231
NUMBER TIED TO RACE/ETHNICITY

613
00:21:11,231 --> 00:21:12,032
WHICH IS 2.5%.

614
00:21:12,032 --> 00:21:15,669
I DON'T THINK WE'RE GOING TO

615
00:21:15,669 --> 00:21:17,738
FIND MUCH IF WE'RE TRYING TO

616
00:21:17,738 --> 00:21:25,045
SOLVE THIS PROBLEM WITH

617
00:21:25,045 --> 00:21:25,479
GENETICS.

618
00:21:25,479 --> 00:21:27,814
IT MAY NOT BE THE ROAD TO GO FOR

619
00:21:27,814 --> 00:21:28,782
DIABETES DISPARITIES.

620
00:21:28,782 --> 00:21:32,052
THAT ROAD GOES RIGHT DOWN THE

621
00:21:32,052 --> 00:21:33,253
LANES OF OBESITY AND SOCIAL

622
00:21:33,253 --> 00:21:34,288
DETERMINANTS OF HEALTH.

623
00:21:34,288 --> 00:21:36,123
I WANT TO STOP FOR A SECOND.

624
00:21:36,123 --> 00:21:40,060
PEOPLE MAY HAVE HEARD OF OR

625
00:21:40,060 --> 00:21:41,928
KNOWN FELICIA HILL BRIGGS, SHE

626
00:21:41,928 --> 00:21:43,330
UNFORTUNATELY DIED LAST YEAR,

627
00:21:43,330 --> 00:21:44,464
WAY TOO EARLY.

628
00:21:44,464 --> 00:21:49,603
SHE WAS -- I HEARD HER SPEAK,

629
00:21:49,603 --> 00:21:50,570
MOTIVATIONAL, INSPIRATIONAL, A

630
00:21:50,570 --> 00:21:52,105
NATIONAL EXPERT ON SOCIAL

631
00:21:52,105 --> 00:21:52,973
DETERMINANTS IN DIABETES.

632
00:21:52,973 --> 00:21:55,175
FOR THOSE WITH AN INTEREST, TO

633
00:21:55,175 --> 00:21:57,244
MY KNOWLEDGE THIS DIABETES CARE

634
00:21:57,244 --> 00:21:58,779
PAPER SHE WROTE IN 2020 IS STILL

635
00:21:58,779 --> 00:22:00,347
THE GOLD STANDARD FOR LOOKING AT

636
00:22:00,347 --> 00:22:01,315
ALL THESE STUDIES.

637
00:22:01,315 --> 00:22:03,183
AND THIS CAME UP EARLIER IN THE

638
00:22:03,183 --> 00:22:04,718
MEET AND GREET, BUT ALL OF THESE

639
00:22:04,718 --> 00:22:06,353
THINGS HAVE BEEN SHOWN TO LINK

640
00:22:06,353 --> 00:22:08,655
TO HIGHER RATES OF DIABETES

641
00:22:08,655 --> 00:22:09,623
AND/OR COMPLICATIONS.

642
00:22:09,623 --> 00:22:12,359
WE SEE THIS AT THE INDIVIDUAL

643
00:22:12,359 --> 00:22:14,328
LEVEL, LOWER INCOME, LOWER

644
00:22:14,328 --> 00:22:16,730
LEVELS OF EDUCATION, LOWER

645
00:22:16,730 --> 00:22:18,465
OCCUPATIONAL GRADE.

646
00:22:18,465 --> 00:22:20,334
AT THE GEOGRAPHIC LEVEL PEOPLE

647
00:22:20,334 --> 00:22:21,868
WHO LIVE IN CENSUS TRACTS ARE

648
00:22:21,868 --> 00:22:23,203
LOWER HIGH SCHOOL GRADUATION

649
00:22:23,203 --> 00:22:24,604
RATES, MORE SINGLE PARENT

650
00:22:24,604 --> 00:22:25,472
HOUSEHOLDS.

651
00:22:25,472 --> 00:22:26,940
WE SEE THIS WITH THE BUILT

652
00:22:26,940 --> 00:22:28,675
ENVIRONMENT, IF THERE'S A HIGHER

653
00:22:28,675 --> 00:22:30,210
LOCAL DENSITY OF FAST FOOD

654
00:22:30,210 --> 00:22:31,178
RESTAURANTS, LOCAL RATES OF

655
00:22:31,178 --> 00:22:32,379
DIABETES ARE HIGHER.

656
00:22:32,379 --> 00:22:35,349
WE SEE THIS WITH SOCIAL CONTEXT,

657
00:22:35,349 --> 00:22:37,584
IF THERE'S LOWER NEIGHBORHOOD

658
00:22:37,584 --> 00:22:40,420
SOCIAL COHESION, THERE'S A STUDY

659
00:22:40,420 --> 00:22:42,422
IN THE MEET AND GREET WE TALKED

660
00:22:42,422 --> 00:22:44,124
ABOUT SHOWED THIS, WHEN YOU HAVE

661
00:22:44,124 --> 00:22:45,792
LOWER COHESION YOU HAVE GREATER

662
00:22:45,792 --> 00:22:47,327
RATES OF DIABETES.

663
00:22:47,327 --> 00:22:49,463
FINALLY WE KNOW THERE'S PEOPLE

664
00:22:49,463 --> 00:22:52,466
WHO REPORT MORE EXPOSURE TO

665
00:22:52,466 --> 00:22:53,667
EVERYDAY RACISM, HIGH RATES OF

666
00:22:53,667 --> 00:22:56,069
DIABETES, BUT I'LL NOTE THAT IS

667
00:22:56,069 --> 00:22:57,604
MEDIATED THROUGH OBESITY WE

668
00:22:57,604 --> 00:22:58,939
THINK BECAUSE ONCE YOU YOU A

669
00:22:58,939 --> 00:23:03,844
JUST FOR BMI THE EXPOSURE IS

670
00:23:03,844 --> 00:23:06,480
HIGHLY ATTENUATED.

671
00:23:06,480 --> 00:23:08,515
WE'VE TALKED ABOUT HOW RACE AND

672
00:23:08,515 --> 00:23:10,417
DIABETES WERE PERCEIVED IN THE

673
00:23:10,417 --> 00:23:10,984
PAST.

674
00:23:10,984 --> 00:23:13,453
ALSO KIND OF THE COMPLEXITY OF

675
00:23:13,453 --> 00:23:15,589
DIABETES, AND WHY I THINK SOCIAL

676
00:23:15,589 --> 00:23:17,124
DETERMINANTS ARE THE WAY WE HAVE

677
00:23:17,124 --> 00:23:19,459
TO GO IF WE TRY TO GET A HANDLE

678
00:23:19,459 --> 00:23:20,727
ON WHERE DIABETES DISPARITIES

679
00:23:20,727 --> 00:23:21,595
ARE NOW.

680
00:23:21,595 --> 00:23:24,431
I WANT TO TURN TO PREVENTION,

681
00:23:24,431 --> 00:23:26,066
MAKE SURE PEOPLE ARE AWARE OF

682
00:23:26,066 --> 00:23:26,867
THE DIABETES PREVENTION PROGRAM

683
00:23:26,867 --> 00:23:28,502
WHICH IS REALLY THE MAIN THING

684
00:23:28,502 --> 00:23:30,871
LIKE I NOTED THAT THIS COUNTRY

685
00:23:30,871 --> 00:23:33,740
IS DOING TO PREVENT DIABETES IN

686
00:23:33,740 --> 00:23:34,608
THE POPULATION.

687
00:23:34,608 --> 00:23:37,577
SO IT SEEMS CRAZY RIGHT NOW BUT

688
00:23:37,577 --> 00:23:39,112
PRIOR TO 1997, WE REALLY DIDN'T

689
00:23:39,112 --> 00:23:41,415
HAVE GREAT DATA SHOWING YOU

690
00:23:41,415 --> 00:23:42,282
COULD PREVENT DIABETES.

691
00:23:42,282 --> 00:23:43,784
THERE WERE SOME PEOPLE WHO

692
00:23:43,784 --> 00:23:45,519
THOUGHT IF YOU GAINED WEIGHT AND

693
00:23:45,519 --> 00:23:49,489
BECAME OBESE IT WAS GOING TO BE

694
00:23:49,489 --> 00:23:50,490
INEVITABLE, AND WE COULDN'T DO

695
00:23:50,490 --> 00:23:52,659
MUCH AT THAT POINT.

696
00:23:52,659 --> 00:23:55,729
BUT THERE WAS FIRST A STUDY IN

697
00:23:55,729 --> 00:23:57,063
CHINA THAT SHOWED IF YOU

698
00:23:57,063 --> 00:23:58,799
INSTITUTED LIFESTYLE CHANGE WITH

699
00:23:58,799 --> 00:24:00,634
DIET AND EXERCISE YOU COULD LOSE

700
00:24:00,634 --> 00:24:02,636
WEIGHT AND THEREFORE PREVENT

701
00:24:02,636 --> 00:24:02,903
DIABETES.

702
00:24:02,903 --> 00:24:03,537
WHICH, AGAIN, WAS TERRIFIC TO

703
00:24:03,537 --> 00:24:06,106
SEE THAT IN A STUDY, NIH JUMPED

704
00:24:06,106 --> 00:24:07,874
ON THIS WHICH IS GREAT AND

705
00:24:07,874 --> 00:24:10,410
LAUNCHED A TRIAL CALLED THE

706
00:24:10,410 --> 00:24:15,148
DIABETES PREVENTION PROGRAM, AN

707
00:24:15,148 --> 00:24:15,782
RCT, PUBLISHED IN 2002, NEW

708
00:24:15,782 --> 00:24:17,651
ENGLAND JOURNAL OF MEDICINE,

709
00:24:17,651 --> 00:24:19,286
REALLY AN EARTHQUAKE TO THE

710
00:24:19,286 --> 00:24:20,020
DIABETES PREVENTION SPACE.

711
00:24:20,020 --> 00:24:21,588
I'LL TALK ABOUT THE STUDY ON A

712
00:24:21,588 --> 00:24:23,123
FEW SLIDES SO YOU KNOW WHAT THEY

713
00:24:23,123 --> 00:24:27,160
DID AND WHAT IT SHOWED.

714
00:24:27,160 --> 00:24:29,129
THE DPT WAS AN RCT CONDUCTED AT

715
00:24:29,129 --> 00:24:30,597
27 CENTERS ACROSS AMERICA.

716
00:24:30,597 --> 00:24:32,332
TO BE ENROLLED THEY TOOK THE

717
00:24:32,332 --> 00:24:35,035
PATIENTS AT HIGHEST RISK.

718
00:24:35,035 --> 00:24:37,437
SO THERE'S DIFFERENT WAYS TO

719
00:24:37,437 --> 00:24:38,538
MEASURE ABNORMAL GLUCOSE

720
00:24:38,538 --> 00:24:39,372
REGULATION.

721
00:24:39,372 --> 00:24:41,041
ONE IS IMPAIRED FASTING GLUCOSE.

722
00:24:41,041 --> 00:24:43,243
IF YOU HAVE AN ELEVATED GLUCOSE

723
00:24:43,243 --> 00:24:45,212
FIRST THING IN THE MORNING ON

724
00:24:45,212 --> 00:24:46,179
EMPTY STOMACH THAT'S ONE SIGN,

725
00:24:46,179 --> 00:24:49,349
YOU HAD TO HAVE THAT.

726
00:24:49,349 --> 00:24:50,684
ALSO THERE'S SOMETHING CALLED

727
00:24:50,684 --> 00:24:51,351
GLUCOSE TOLERANCE TEST.

728
00:24:51,351 --> 00:24:53,086
IF ANY OF YOU HAVE BEEN PREGNANT

729
00:24:53,086 --> 00:24:58,558
OR HAD A BABY YOU KNOW YOU HAVE

730
00:24:58,558 --> 00:25:00,994
TO DRINK THAT SYRUPY SWEET

731
00:25:00,994 --> 00:25:02,963
LIQUID AND HAVE BLOOD DRAWN OVER

732
00:25:02,963 --> 00:25:07,100
TIME TO SEE HOW YOUR BODY

733
00:25:07,100 --> 00:25:16,076
REGULATES THE LOAD.

734
00:25:16,076 --> 00:25:19,012
WITH BOTH WERE THE PEOPLE

735
00:25:19,012 --> 00:25:19,546
ENROLLED.

736
00:25:19,546 --> 00:25:21,448
PEOPLE DESIGNING IT REALIZE

737
00:25:21,448 --> 00:25:23,083
WHERE DIABETES DISPARITIES WERE

738
00:25:23,083 --> 00:25:25,585
HEAD AND MADE HERCULEAN EFFORT

739
00:25:25,585 --> 00:25:27,220
TO MAKE IT DIVERSE, 45%

740
00:25:27,220 --> 00:25:27,521
NON-WHITE.

741
00:25:27,521 --> 00:25:28,955
A COLLEAGUE TELLS ME AT THE TIME

742
00:25:28,955 --> 00:25:30,824
IT WAS THE MOST DIVERSE TRIAL IN

743
00:25:30,824 --> 00:25:33,126
THE HISTORY OF NIH.

744
00:25:33,126 --> 00:25:34,861
AND NO ONE HAS CONTRADICTED ME

745
00:25:34,861 --> 00:25:35,362
ON THAT YET.

746
00:25:35,362 --> 00:25:37,364
AT THE TIME I THINK IT WAS

747
00:25:37,364 --> 00:25:39,599
NUMBER ONE, MAYBE THERE WERE

748
00:25:39,599 --> 00:25:42,969
SOME SINCE.

749
00:25:42,969 --> 00:25:46,940
20% BLACK, 16% LATINO, 5%

750
00:25:46,940 --> 00:25:48,341
AMERICAN INDIAN, 4% ASIAN.

751
00:25:48,341 --> 00:25:50,944
THIS WAS THE INTERVENTION.

752
00:25:50,944 --> 00:25:53,046
THERE WERE THREE ARMS REPORTED

753
00:25:53,046 --> 00:25:56,016
IN THE NEW ENGLAND JOURNAL

754
00:25:56,016 --> 00:25:57,984
PAPER, ONE WAS LIFESTYLE CHANGE.

755
00:25:57,984 --> 00:26:02,255
ONE WAS MEDICATION MET FOR 

756
00:26:02,255 --> 00:26:04,324
METFORMIN AND PLACEBO ARM.

757
00:26:04,324 --> 00:26:05,692
A FOURTH WAS A MEDICINE PULLED

758
00:26:05,692 --> 00:26:07,827
OFF THE MARKET BECAUSE OF SIDE

759
00:26:07,827 --> 00:26:09,563
EFFECTS, THAT WASN'T REPORTED,

760
00:26:09,563 --> 00:26:11,965
WE DON'T PRESCRIBE THAT

761
00:26:11,965 --> 00:26:12,566
CURRENTLY.

762
00:26:12,566 --> 00:26:14,834
THE LIFESTYLE CHANGE, THE

763
00:26:14,834 --> 00:26:16,903
ORIGINAL GOAL WAS LOSE 7% OF

764
00:26:16,903 --> 00:26:17,571
BODY WEIGHT.

765
00:26:17,571 --> 00:26:21,074
A NOTE IN BOLD IN THIS RCT WAS

766
00:26:21,074 --> 00:26:24,678
DONE, 1:1 WITH LIFESTYLE COACH,

767
00:26:24,678 --> 00:26:25,278
SO INTENSIVE INDIVIDUAL

768
00:26:25,278 --> 00:26:27,314
ATTENTION, GOING OVER THE

769
00:26:27,314 --> 00:26:29,282
CURRICULUM WHICH WAS DELIVERED

770
00:26:29,282 --> 00:26:31,384
FIRST IN 16 WEEKS, WHICH

771
00:26:31,384 --> 00:26:34,354
INCLUDED DIET, INFORMATION ON

772
00:26:34,354 --> 00:26:36,957
DIETARY CHANGE, ON EXERCISE,

773
00:26:36,957 --> 00:26:38,291
ALSO BEHAVIOR MODIFICATION.

774
00:26:38,291 --> 00:26:39,259
THERE'S AN EFFORT TO WORK WITH

775
00:26:39,259 --> 00:26:40,360
PEOPLE TO, FOR EXAMPLE, LEARN

776
00:26:40,360 --> 00:26:42,329
HOW TO SAY NO IF YOU'RE AT AN

777
00:26:42,329 --> 00:26:43,763
OFFICE PARTY AND THE TABLE IS

778
00:26:43,763 --> 00:26:45,498
FULL OF CAKES AND COOKIES AND

779
00:26:45,498 --> 00:26:47,033
CANDY, HOW DO YOU DECLINE?

780
00:26:47,033 --> 00:26:49,569
MAYBE IF YOU FALL OFF THE WAGON,

781
00:26:49,569 --> 00:26:50,870
CHANGE YOUR LIFESTYLE BACK, HOW

782
00:26:50,870 --> 00:26:53,373
DO YOU GET BACK, REORIENT

783
00:26:53,373 --> 00:26:54,808
YOURSELF, PREPARING PEOPLE TO

784
00:26:54,808 --> 00:26:56,209
MAKE AND SUSTAIN LIFESTYLE

785
00:26:56,209 --> 00:26:56,443
CHANGE.

786
00:26:56,443 --> 00:26:57,744
THAT'S THE GOAL OF THE

787
00:26:57,744 --> 00:26:58,044
CURRICULUM.

788
00:26:58,044 --> 00:27:01,047
THEN THERE WERE AFTER THE 16

789
00:27:01,047 --> 00:27:02,682
WEEKS, EIGHT MONTHLY BOOSTER

790
00:27:02,682 --> 00:27:04,217
SESSIONS TO REINFORCE WHAT

791
00:27:04,217 --> 00:27:05,852
PEOPLE LEARNED, TO SUPPORT THEM

792
00:27:05,852 --> 00:27:09,889
IN MAKING THIS CHANGE.

793
00:27:09,889 --> 00:27:12,626
SO OVERALL 12-MONTH YEAR-LONG

794
00:27:12,626 --> 00:27:13,393
CURRICULUM.

795
00:27:13,393 --> 00:27:14,561
WHAT WERE THE RESULTS?

796
00:27:14,561 --> 00:27:15,795
THEY WERE GREAT.

797
00:27:15,795 --> 00:27:17,664
THIS IS THE DPP RESULT, FAMOUS

798
00:27:17,664 --> 00:27:21,267
GRAPH THAT WE KNOW WELL IN THIS

799
00:27:21,267 --> 00:27:21,468
FIELD.

800
00:27:21,468 --> 00:27:25,105
X-AXIS IS TIME, STUDY WENT

801
00:27:25,105 --> 00:27:25,972
STOPPED PREMATURELY BEFORE FIVE

802
00:27:25,972 --> 00:27:29,376
YEARS BECAUSE OF THE BENEFITS.

803
00:27:29,376 --> 00:27:30,577
THE Y-AXIS IS CUMULATIVE

804
00:27:30,577 --> 00:27:31,778
INCIDENCE OF DIABETES.

805
00:27:31,778 --> 00:27:33,980
YOU CAN SEE RATE OF DIABETES WAS

806
00:27:33,980 --> 00:27:37,717
HIGHEST IN THE PLACEBO ARM, BLUE

807
00:27:37,717 --> 00:27:37,884
ARM.

808
00:27:37,884 --> 00:27:38,451
PEOPLE TAKING METFORMIN

809
00:27:38,451 --> 00:27:42,222
RANDOMIZED TO THAT ARM ARE LOWER

810
00:27:42,222 --> 00:27:43,857
INCIDENCE.

811
00:27:43,857 --> 00:27:45,825
PEOPLE RANDOMIZED TO LIFESTYLE

812
00:27:45,825 --> 00:27:47,694
ARM HAD LOWEST INCIDENCE, 58%

813
00:27:47,694 --> 00:27:49,763
REDUCTION AT AROUND FOUR YEARS.

814
00:27:49,763 --> 00:27:51,231
AGAIN, HUGE STUDY, REALLY SHOOK

815
00:27:51,231 --> 00:27:52,532
EVERYONE, THIS IS WHAT WE HAVE

816
00:27:52,532 --> 00:27:52,966
TO DO.

817
00:27:52,966 --> 00:27:56,469
NOW WE HAVE TO FIGURE OUT HOW TO

818
00:27:56,469 --> 00:27:57,103
DO IT.

819
00:27:57,103 --> 00:27:58,438
BUT I WANTED TO THEN SHOW ALSO

820
00:27:58,438 --> 00:28:00,273
THAT ONE OF THE EXCITING THINGS

821
00:28:00,273 --> 00:28:02,342
ABOUT IT WAS IT WORKED JUST AS

822
00:28:02,342 --> 00:28:03,677
WELL AS IF NOT BETTER FOR

823
00:28:03,677 --> 00:28:05,211
PERSONS OF COLOR WHICH MADE IT

824
00:28:05,211 --> 00:28:06,312
EVEN MORE EXCITING.

825
00:28:06,312 --> 00:28:08,948
THIS IS THE SUBGROUP I

826
00:28:08,948 --> 00:28:10,116
MENTIONED, 58% OVERALL REDUCTION

827
00:28:10,116 --> 00:28:11,918
INCIDENCE, BUT FOR WHITE

828
00:28:11,918 --> 00:28:13,420
PATIENTS IT WAS 51%.

829
00:28:13,420 --> 00:28:14,421
STILL GOOD BUT CERTAINLY BETTER

830
00:28:14,421 --> 00:28:16,256
FOR OTHER GROUPS.

831
00:28:16,256 --> 00:28:18,892
YOU SEE BLACK PATIENTS, 61%

832
00:28:18,892 --> 00:28:21,227
REDUCTION IN INCIDENCE.

833
00:28:21,227 --> 00:28:23,396
LATINO 66% REDUCTION.

834
00:28:23,396 --> 00:28:24,731
AMERICAN INDIAN, 65%.

835
00:28:24,731 --> 00:28:27,333
ASIAN AS HIGH AS 71%.

836
00:28:27,333 --> 00:28:29,436
IN THE RCT THIS WORKED

837
00:28:29,436 --> 00:28:31,171
TREMENDOUSLY, GREAT HOPE THIS

838
00:28:31,171 --> 00:28:33,039
CAN REDUCE DISPARITIES IN

839
00:28:33,039 --> 00:28:35,008
DIABETES PREVALENCE, AND THEN

840
00:28:35,008 --> 00:28:36,509
DOWNSTREAM OF COURSE ALSO

841
00:28:36,509 --> 00:28:37,477
DIABETES COMPLICATIONS.

842
00:28:37,477 --> 00:28:38,712
SO VERY EXCITING.

843
00:28:38,712 --> 00:28:41,081
WE'LL COME BACK TO WHAT HAS

844
00:28:41,081 --> 00:28:42,449
ACTUALLY HAPPENED SINCE 2002 IN

845
00:28:42,449 --> 00:28:45,952
THE REAL WORLD IN A FEW MINUTES.

846
00:28:45,952 --> 00:28:47,387
I'LL SAY THIS.

847
00:28:47,387 --> 00:28:49,456
THERE'S SOMETHING CALLED THE DPP

848
00:28:49,456 --> 00:28:50,423
OUTCOME STUDY.

849
00:28:50,423 --> 00:28:52,959
AND THIS BASICALLY AS YOU SEE ON

850
00:28:52,959 --> 00:29:00,900
THE LEFT, ALL THE PARTICIPANTS,

851
00:29:00,900 --> 00:29:02,802
88% CONSENTED TO BE FOLLOWED

852
00:29:02,802 --> 00:29:03,470
OVER TIME.

853
00:29:03,470 --> 00:29:04,437
RANDOMIZATION WAS BROKEN AND

854
00:29:04,437 --> 00:29:05,271
THEY WERE OFFERED LIFESTYLE

855
00:29:05,271 --> 00:29:06,940
CHANGE BECAUSE OF RESULTS I

856
00:29:06,940 --> 00:29:07,340
MENTIONED.

857
00:29:07,340 --> 00:29:11,544
AND MANY OF THEM TOOK IT UP, IT

858
00:29:11,544 --> 00:29:12,746
WAS A CROSSOVER STUDY, WE

859
00:29:12,746 --> 00:29:14,481
FOLLOWED REGARDLESS OF WHAT THEY

860
00:29:14,481 --> 00:29:14,848
DID AFTERWARD.

861
00:29:14,848 --> 00:29:16,816
STILL TIED TO THEIR INITIAL

862
00:29:16,816 --> 00:29:17,784
RANDOMIZATION IN THE DPP.

863
00:29:17,784 --> 00:29:21,187
SO ON THE RIGHT YOU CAN SEE THIS

864
00:29:21,187 --> 00:29:22,355
IN GRAPHICAL FORM.

865
00:29:22,355 --> 00:29:25,225
DPP IS ARROW ON THE LEFT.

866
00:29:25,225 --> 00:29:26,993
RIGHT AROUND THAT 4-YEAR MARK

867
00:29:26,993 --> 00:29:28,194
PEOPLE WERE SWITCHED AND

868
00:29:28,194 --> 00:29:29,496
FOLLOWED OVER TIME.

869
00:29:29,496 --> 00:29:34,334
AND WE NOW SEE EVEN AT 15 YEARS

870
00:29:34,334 --> 00:29:36,169
LATER, BENEFITS STILL PERSIST.

871
00:29:36,169 --> 00:29:38,371
YOU CAN STILL SEE WITH Y-AXIS

872
00:29:38,371 --> 00:29:40,073
INCIDENCE WITH DIABETES, HIGHEST

873
00:29:40,073 --> 00:29:41,808
AMONG PEOPLE IN THE ORIGINAL

874
00:29:41,808 --> 00:29:43,510
PLACEBO ARM, REGARDLESS OF WHAT

875
00:29:43,510 --> 00:29:44,711
THEY DID SINCE.

876
00:29:44,711 --> 00:29:46,780
AND THEN YOU SEE METFORMIN

877
00:29:46,780 --> 00:29:48,615
LIFESTYLE ARMS CONVERGING OVER

878
00:29:48,615 --> 00:29:51,384
TIME BUT STILL MUCH BETTER THAN

879
00:29:51,384 --> 00:29:51,618
PLACEBO.

880
00:29:51,618 --> 00:29:54,854
SO EVEN THAT ONE YEAR OF DPP 15

881
00:29:54,854 --> 00:29:56,856
YEARS AGO, WE STILL SEE

882
00:29:56,856 --> 00:29:59,159
FOOTPRINT IN PEOPLE WITH

883
00:29:59,159 --> 00:30:00,560
DIABETES RATES 15 YEARS DOWN THE

884
00:30:00,560 --> 00:30:01,761
LINE, EVEN MORE EXCITEMENT ABOUT

885
00:30:01,761 --> 00:30:05,031
WHAT THE POWER OF THIS

886
00:30:05,031 --> 00:30:06,132
INTERVENTION WILL BE.

887
00:30:06,132 --> 00:30:06,399
ALL RIGHT.

888
00:30:06,399 --> 00:30:08,701
SO I WANTED TO BEFORE I TALK

889
00:30:08,701 --> 00:30:10,970
ABOUT DISPARITIES, LIKE I NOTED,

890
00:30:10,970 --> 00:30:12,505
HIT ON DIABETES SCREENING

891
00:30:12,505 --> 00:30:15,475
GUIDELINES. 

892
00:30:15,475 --> 00:30:16,876
REALLY IT'S A TWO-PART APPROACH.

893
00:30:16,876 --> 00:30:18,645
YOU WANT TO SCREEN PEOPLE.

894
00:30:18,645 --> 00:30:20,079
ONCE THEY SCREEN POSITIVE,

895
00:30:20,079 --> 00:30:20,547
PREVENT.

896
00:30:20,547 --> 00:30:21,815
WE TALKED ABOUT PREVENTION.

897
00:30:21,815 --> 00:30:25,518
WHAT'S THE STORY WITH SCREENING?

898
00:30:25,518 --> 00:30:27,187
SO I THINK REALLY ANY CONDITION

899
00:30:27,187 --> 00:30:29,389
IN ORDER FOR THERE TO BE A

900
00:30:29,389 --> 00:30:30,056
JUSTIFIED SCREENING PROGRAM, IT

901
00:30:30,056 --> 00:30:31,658
HAS TO MEET AT LEAST FOUR

902
00:30:31,658 --> 00:30:32,225
CRITERIA.

903
00:30:32,225 --> 00:30:33,293
THERE'S SOME OTHER ONES THAT

904
00:30:33,293 --> 00:30:35,628
PEOPLE MAY BRING INTO THIS.

905
00:30:35,628 --> 00:30:37,363
THE FIRST IS DISEASE SHOULD BE

906
00:30:37,363 --> 00:30:38,565
AN IMPORTANT PUBLIC HEALTH

907
00:30:38,565 --> 00:30:41,634
PROBLEM, AS WE TALKED ABOUT AT

908
00:30:41,634 --> 00:30:42,735
THE BEGINNING, YES, DIABETES IS

909
00:30:42,735 --> 00:30:44,704
AN IMPORTANT PUBLIC HEALTH

910
00:30:44,704 --> 00:30:44,938
PROBLEM.

911
00:30:44,938 --> 00:30:47,440
NUMBER TWO, THE DISEASE SHOULD

912
00:30:47,440 --> 00:30:48,408
HAVE A DETECTABLE PRE-CLINICAL

913
00:30:48,408 --> 00:30:51,578
PHASE, AND IT HAS THAT,

914
00:30:51,578 --> 00:30:54,314
PREDIABETES, BEFORE YOU REACH

915
00:30:54,314 --> 00:30:55,648
THE LEVELS DIAGNOSTIC AS

916
00:30:55,648 --> 00:30:55,915
DIABETES.

917
00:30:55,915 --> 00:30:57,817
NUMBER THREE, TREATMENT OF THE

918
00:30:57,817 --> 00:30:59,352
DISEASE PRE-SYMPTOM SHOULD OFFER

919
00:30:59,352 --> 00:31:00,453
A BENEFIT.

920
00:31:00,453 --> 00:31:01,754
AND AS WE DISCUSSED, MAYBE IN

921
00:31:01,754 --> 00:31:03,022
THE PAST THAT WASN'T ENTIRELY

922
00:31:03,022 --> 00:31:05,158
CLEAR, BUT NOW WE KNOW IT DOES,

923
00:31:05,158 --> 00:31:06,125
THAT'S THE DPP.

924
00:31:06,125 --> 00:31:07,694
IF YOU TREAT THESE PEOPLE BEFORE

925
00:31:07,694 --> 00:31:09,329
THEY REACH DIABETES, YOU CAN

926
00:31:09,329 --> 00:31:10,563
ACTUALLY OFFER A BENEFIT IN

927
00:31:10,563 --> 00:31:12,832
TERMS OF LOWER RATES OF DIABETES

928
00:31:12,832 --> 00:31:14,601
DOWN THE LINE.

929
00:31:14,601 --> 00:31:15,702
FOUR, THE SCREENING TEST SHOULD

930
00:31:15,702 --> 00:31:19,105
BE ACCEPTABLE TO PATIENTS AND

931
00:31:19,105 --> 00:31:19,372
PROVIDERS.

932
00:31:19,372 --> 00:31:21,307
SO IT USED TO BE FOR EXAMPLE YOU

933
00:31:21,307 --> 00:31:23,076
HAD TO HAVE A FASTING GLUCOSE

934
00:31:23,076 --> 00:31:24,410
REQUIRING THE PERSON TO COME ON

935
00:31:24,410 --> 00:31:26,012
EMPTY STOMACH IN THE MORNING AND

936
00:31:26,012 --> 00:31:27,981
THAT COULD BE DIFFICULT.

937
00:31:27,981 --> 00:31:30,283
OR GLUCOSE TOLERANCE TEST, WHICH

938
00:31:30,283 --> 00:31:32,118
IS ALSO DIFFICULT, YOU HAVE TO

939
00:31:32,118 --> 00:31:35,622
SIT FOR A COUPLE HOURS, MULTIPLE

940
00:31:35,622 --> 00:31:36,656
STICKS.

941
00:31:36,656 --> 00:31:40,260
NOW WE HAVE HEMOGLOBIN A1c

942
00:31:40,260 --> 00:31:44,530
TESTING, SHOWN TO BE -- EVEN

943
00:31:44,530 --> 00:31:45,732
ENDOCRINOLOGISTS ACCEPT THIS AS

944
00:31:45,732 --> 00:31:47,600
A WAY TO GO, IN THE LAB OR

945
00:31:47,600 --> 00:31:47,834
CLINIC.

946
00:31:47,834 --> 00:31:48,801
MANY HAVE POINT OF CARE

947
00:31:48,801 --> 00:31:50,236
MACHINES, YOU CAN COME IN, DO IT

948
00:31:50,236 --> 00:31:52,639
RIGHT THERE IN THE CLINIC AND

949
00:31:52,639 --> 00:31:55,675
GET YOUR TESTING AND A1C LEVEL.

950
00:31:55,675 --> 00:31:57,243
GIVEN DIABETES MEETS ALL FOUR

951
00:31:57,243 --> 00:31:59,545
CRITERIA, I THINK TO ME IT'S A

952
00:31:59,545 --> 00:32:01,881
SLAM DUNK THAT WE SHOULD SCREEN

953
00:32:01,881 --> 00:32:03,483
AND FORTUNATELY THE UNITED

954
00:32:03,483 --> 00:32:07,954
STATES  PREVENTIVE SERVICES TASK

955
00:32:07,954 --> 00:32:09,289
FORCE AGREES.

956
00:32:09,289 --> 00:32:12,458
THIS IS THE CURRENT ONE WE'RE

957
00:32:12,458 --> 00:32:13,426
OPERATING UNDER NOW.

958
00:32:13,426 --> 00:32:16,729
AS OF TODAY THERE ARE GUIDELINES

959
00:32:16,729 --> 00:32:20,233
THAT ANYONE WHOO IS ASYMPTOMATIC

960
00:32:20,233 --> 00:32:23,536
AGE 35 TO 70 WITH OVERWEIGHT OR

961
00:32:23,536 --> 00:32:26,706
OBESITY SHOULD BE SCREENED FOR

962
00:32:26,706 --> 00:32:28,207
PREDIABETES/TYPE 2 DIABETES.

963
00:32:28,207 --> 00:32:30,009
NOTE AT THE BOTTOM, IN THE FINE

964
00:32:30,009 --> 00:32:32,278
PRINT, OVERWEIGHT SHOULD BE

965
00:32:32,278 --> 00:32:33,813
DEFINED AS BMI GREATER OR EQUAL

966
00:32:33,813 --> 00:32:36,115
TO 25 BUT THERE'S DATA

967
00:32:36,115 --> 00:32:37,016
SUGGESTING BMI GREATER THAN

968
00:32:37,016 --> 00:32:38,851
EQUAL TO 23 SHOULD BE THE CUT

969
00:32:38,851 --> 00:32:42,121
POINT FOR ASIAN AMERICAN

970
00:32:42,121 --> 00:32:43,222
PERSONS, THIS IS BECAUSE OBESITY

971
00:32:43,222 --> 00:32:45,625
RATES TEND TO BE LOWER AND RATES

972
00:32:45,625 --> 00:32:47,160
OF DIABETES TEND TO BE AT

973
00:32:47,160 --> 00:32:49,462
DIFFERENT SET POINTS, WE'LL TALK

974
00:32:49,462 --> 00:32:51,431
ABOUT THAT LATER.

975
00:32:51,431 --> 00:32:52,498
REGARDLESS, GUIDELINES CALL FOR

976
00:32:52,498 --> 00:32:54,367
SCREENING FOR OVERWEIGHT.

977
00:32:54,367 --> 00:32:55,702
MOST PEOPLE 25+.

978
00:32:55,702 --> 00:32:57,770
THIS IS GENERALLY RECOMMENDED TO

979
00:32:57,770 --> 00:32:59,439
BE DONE EVERY THREE YEARS, IF

980
00:32:59,439 --> 00:33:01,074
YOU DON'T HAVE PREDIABETES.

981
00:33:01,074 --> 00:33:04,777
IF YOU HAVE PREDIABETES SHOULD

982
00:33:04,777 --> 00:33:05,745
BE ANNUAL.

983
00:33:05,745 --> 00:33:08,281
THE POINT IS ONCE PEOPLE SCREEN

984
00:33:08,281 --> 00:33:10,016
POSITIVE, THEY SHOULD --

985
00:33:10,016 --> 00:33:15,488
CLINICIANS SHOULD OFFER OR REFER

986
00:33:15,488 --> 00:33:17,123
PATIENTS WITH PREDIABETES TO

987
00:33:17,123 --> 00:33:19,092
INTERVENTION, THE PREVENTION

988
00:33:19,092 --> 00:33:21,160
PROGRAM OR METFORMIN.

989
00:33:21,160 --> 00:33:23,696
WHY IS THIS A GRADE OF B, NOT A?

990
00:33:23,696 --> 00:33:25,598
WE HAVEN'T SEEN MORTALITY

991
00:33:25,598 --> 00:33:27,433
BENEFITS WITH DIABETES SCREENING

992
00:33:27,433 --> 00:33:29,035
WE WOULD LIKE.

993
00:33:29,035 --> 00:33:32,572
AND B IS ALSO A STRONGER,

994
00:33:32,572 --> 00:33:33,873
COVERED BY INSURANCE, SOMETHING

995
00:33:33,873 --> 00:33:35,074
WE SHOULD BE DOING.

996
00:33:35,074 --> 00:33:38,111
I'LL TALK IN A MINUTE HOW WELL

997
00:33:38,111 --> 00:33:39,979
WE ARE OR NOT DOING FOLLOWING

998
00:33:39,979 --> 00:33:40,713
THIS RECOMMENDATION PARTICULARLY

999
00:33:40,713 --> 00:33:43,850
AS IT COMES TO GROUPS OF

1000
00:33:43,850 --> 00:33:44,884
DIFFERENT RACE AND ETHNICITY.

1001
00:33:44,884 --> 00:33:46,452
I'LL TALK ABOUT THAT NOW.

1002
00:33:46,452 --> 00:33:49,288
SO, THIS IS THE PART OF THE TALK

1003
00:33:49,288 --> 00:33:56,429
ON DISPARITIES AND DIABETES

1004
00:33:56,429 --> 00:33:57,964
SCREENING AND PREVENTION.

1005
00:33:57,964 --> 00:33:59,699
THIS IS FROM 2017, USED TO BE

1006
00:33:59,699 --> 00:34:02,635
THE AGE WAS 45+, KNOW AS

1007
00:34:02,635 --> 00:34:03,503
MENTIONED IT WAS 35.

1008
00:34:03,503 --> 00:34:08,775
YOU USED TO HAVE SOME OTHER

1009
00:34:08,775 --> 00:34:09,642
CONDITION BESIDES OVERWEIGHT,

1010
00:34:09,642 --> 00:34:10,443
OFTEN HYPERTENSION.

1011
00:34:10,443 --> 00:34:12,278
PEOPLE OVER 45 WITH SOMETHING

1012
00:34:12,278 --> 00:34:14,113
LIKE HYPERTENSION, THESE WERE

1013
00:34:14,113 --> 00:34:15,948
THE SCREENING RATES REPORTED

1014
00:34:15,948 --> 00:34:16,849
THROUGH NHANES, SELF-REPORT.

1015
00:34:16,849 --> 00:34:22,555
AS YOU CAN SEE OVERALL WE'RE NOT

1016
00:34:22,555 --> 00:34:24,190
DOING TERRIFICALLY, 60% RANGE

1017
00:34:24,190 --> 00:34:26,059
MORE MOST GROUPS, BUT SURPRISING

1018
00:34:26,059 --> 00:34:28,594
FOR ASIAN PATIENTS, ASIAN

1019
00:34:28,594 --> 00:34:30,229
INDIVIDUALS, ONLY 51% SO

1020
00:34:30,229 --> 00:34:31,964
SIGNIFICANTLY LOWER FOR THIS

1021
00:34:31,964 --> 00:34:33,499
GROUP JUST NOT GETTING SCREENED

1022
00:34:33,499 --> 00:34:35,668
AT RATES OTHER GROUPS SHOULD.

1023
00:34:35,668 --> 00:34:37,670
YOU MAY SAY, WELL, MAYBE THIS IS

1024
00:34:37,670 --> 00:34:40,173
BECAUSE ASIAN PATIENTS MAY HAVE

1025
00:34:40,173 --> 00:34:42,041
LOWER BMI AND MAY NOT BE

1026
00:34:42,041 --> 00:34:43,142
TRIGGERING IN THE MIND OF THE

1027
00:34:43,142 --> 00:34:44,577
CLINICIAN THEY SHOULD BE

1028
00:34:44,577 --> 00:34:45,044
SCREENED.

1029
00:34:45,044 --> 00:34:46,746
WHEN YOU SUBSET THE PAPER AND

1030
00:34:46,746 --> 00:34:50,283
PEOPLE WITH BMI OF 30 AND ABOVE,

1031
00:34:50,283 --> 00:34:52,118
PRETTY CLEAR ALL THESE PEOPLE

1032
00:34:52,118 --> 00:34:54,220
HAVE OBESITY, YOU SEE THIS

1033
00:34:54,220 --> 00:34:56,055
DISPARITY PERSIST, YOU SEE

1034
00:34:56,055 --> 00:34:57,824
SCREENING RATES FOR WHITE,

1035
00:34:57,824 --> 00:34:58,825
BLACK, LATINO PATIENTS HIGHER

1036
00:34:58,825 --> 00:34:59,792
THAN WITHOUT THE SUBSET.

1037
00:34:59,792 --> 00:35:01,461
AGAIN THESE ARE PEOPLE AT HIGHER

1038
00:35:01,461 --> 00:35:07,333
RISK, WE ALL KNOW THAT, IN THE

1039
00:35:07,333 --> 00:35:08,334
70s, ASIAN PATIENTS STILL

1040
00:35:08,334 --> 00:35:09,869
STUCK AT 60%.

1041
00:35:09,869 --> 00:35:11,003
THIS IS AN UNDERSTUDIED AREA WE

1042
00:35:11,003 --> 00:35:13,372
NEED TO TALK MORE ABOUT.

1043
00:35:13,372 --> 00:35:15,241
FIRST THING IS TO REALLY LOOK AT

1044
00:35:15,241 --> 00:35:16,442
SUBGROUPS BECAUSE WE KNOW THAT

1045
00:35:16,442 --> 00:35:18,177
RATES, FOR EXAMPLE, OF DIABETES

1046
00:35:18,177 --> 00:35:20,613
ARE HIGHEST AMONG ASIAN PATIENTS

1047
00:35:20,613 --> 00:35:22,582
IN TERMS OF FILIPINO AMERICANS

1048
00:35:22,582 --> 00:35:30,890
AND SOUTH ASIAN INDIAN 

1049
00:35:30,890 --> 00:35:34,827
AMERICANS, YOU WOULD 

1050
00:35:34,827 --> 00:35:36,095
HYPOTHESIZE THOSE RATES WOULD BE

1051
00:35:36,095 --> 00:35:38,464
HIGHER, WE NEED TO FIGURE OUT

1052
00:35:38,464 --> 00:35:38,998
WHY.

1053
00:35:38,998 --> 00:35:40,533
THIS GOES BACK TO PHYSICIANS IN

1054
00:35:40,533 --> 00:35:41,968
THEIR MIND GET A SENSE OF WHO

1055
00:35:41,968 --> 00:35:42,535
HAS DIABETES.

1056
00:35:42,535 --> 00:35:44,504
USED TO BE JEWISH PEOPLE HAD

1057
00:35:44,504 --> 00:35:44,770
DIABETES.

1058
00:35:44,770 --> 00:35:45,471
BLACK PEOPLE DIDN'T.

1059
00:35:45,471 --> 00:35:49,308
AND THEN YOU SAW OVER TIME

1060
00:35:49,308 --> 00:35:51,911
INDIAN PEOPLE, PIMA INDIANS TEND

1061
00:35:51,911 --> 00:35:54,247
TO HAVE DIABETES, MEXICAN

1062
00:35:54,247 --> 00:35:55,581
AMERICANS HAVE DIABETES.

1063
00:35:55,581 --> 00:35:57,984
THERE MAY BE CLINICIAN BIAS,

1064
00:35:57,984 --> 00:35:58,851
LESS THINKING ASIAN PATIENTS DO,

1065
00:35:58,851 --> 00:35:59,919
REALLY AN IMPORTANT AREA FOR

1066
00:35:59,919 --> 00:36:01,154
WORK WE NEED TO DO IF WE'RE

1067
00:36:01,154 --> 00:36:04,023
TRYING TO GET THE SCREENING RATE

1068
00:36:04,023 --> 00:36:06,292
UP, FOR ASIAN PATIENTS TO

1069
00:36:06,292 --> 00:36:08,594
APPROXIMATE THOSE OF OTHER

1070
00:36:08,594 --> 00:36:09,462
GROUPS.

1071
00:36:09,462 --> 00:36:11,898
I WILL SAY ONE AREA WHERE PEOPLE

1072
00:36:11,898 --> 00:36:18,037
OF ASIAN DESCENT ARE SCREENED AT

1073
00:36:18,037 --> 00:36:20,439
HIGHEST RACE IS GESTATIONAL

1074
00:36:20,439 --> 00:36:21,741
DIABETES MELLITUS.

1075
00:36:21,741 --> 00:36:22,375
THE CONDITION DURING PREGNANCY

1076
00:36:22,375 --> 00:36:25,344
WHEN YOU GAIN WEIGHT AS YOU

1077
00:36:25,344 --> 00:36:27,713
SHOULD, AND SUGAR TENDS TO GO

1078
00:36:27,713 --> 00:36:29,849
UP, GDM, NOT AS HIGH AS TYPE 2

1079
00:36:29,849 --> 00:36:31,918
DIABETES BUT TO A POINT WHERE IT

1080
00:36:31,918 --> 00:36:32,785
BECOMES IMPORTANT TO MANAGE IT

1081
00:36:32,785 --> 00:36:36,155
FOR THE SAFETY OF BOTH THE MOM

1082
00:36:36,155 --> 00:36:36,489
AND THE BABY.

1083
00:36:36,489 --> 00:36:39,559
AND SO ON.

1084
00:36:39,559 --> 00:36:45,164
AND 

1085
00:36:45,164 --> 00:36:46,799
AND SO THE OBs SCREEN AND

1086
00:36:46,799 --> 00:36:48,234
TREAT PEOPLE OFTEN WITH INSULIN

1087
00:36:48,234 --> 00:36:49,202
UNTIL THEY DELIVER.

1088
00:36:49,202 --> 00:36:51,837
THE KEY IS WHAT HAPPENS AFTER

1089
00:36:51,837 --> 00:36:52,038
THAT.

1090
00:36:52,038 --> 00:36:53,372
SO, PEOPLE TEND TO LOSE WEIGHT,

1091
00:36:53,372 --> 00:36:55,541
OF COURSE, BECAUSE THEY ARE NO

1092
00:36:55,541 --> 00:36:56,542
LONGER PREGNANT, OFTEN BLOOD

1093
00:36:56,542 --> 00:36:58,411
SUGAR GOES BACK TO NORMAL.

1094
00:36:58,411 --> 00:36:59,712
SOME PEOPLE FORGET ABOUT THIS

1095
00:36:59,712 --> 00:37:00,613
AND DON'T FOLLOW UP.

1096
00:37:00,613 --> 00:37:02,481
I TELL MY PATIENTS IT'S LIKE

1097
00:37:02,481 --> 00:37:04,016
HAVING A CHECK ENGINE LIGHT.

1098
00:37:04,016 --> 00:37:06,719
EVEN IF YOU CHECK ENGINE LIGHT

1099
00:37:06,719 --> 00:37:07,853
GOES OFF BECAUSE YOU LOST WEIGHT

1100
00:37:07,853 --> 00:37:09,021
THERE'S SOMETHING GOING ON UNDER

1101
00:37:09,021 --> 00:37:10,623
THE HOOD WE NEED TO PAY

1102
00:37:10,623 --> 00:37:12,792
ATTENTION TO, BECAUSE THIS IS

1103
00:37:12,792 --> 00:37:16,495
PROBABLY THE GROUP THE SINGLE

1104
00:37:16,495 --> 00:37:17,196
GREATEST RISK OF DEVELOPING

1105
00:37:17,196 --> 00:37:18,030
DIABETES OVER TIME.

1106
00:37:18,030 --> 00:37:19,565
BECAUSE OF THAT THERE ARE CLEAR

1107
00:37:19,565 --> 00:37:21,133
GUIDELINES WOMEN SHOULD COME

1108
00:37:21,133 --> 00:37:22,702
BACK FOR POSTPARTUM SCREENING

1109
00:37:22,702 --> 00:37:23,302
FOR DIABETES.

1110
00:37:23,302 --> 00:37:25,404
THEY ARE SUPPOSED TO SEE THEIR

1111
00:37:25,404 --> 00:37:29,108
OB AND 6 WEEKS, AND THEN IDEALLY

1112
00:37:29,108 --> 00:37:30,543
TRANSITION TO PCP TO FOLLOW

1113
00:37:30,543 --> 00:37:32,378
AFTER THAT.

1114
00:37:32,378 --> 00:37:32,812
SO THERE WAS RECENT

1115
00:37:32,812 --> 00:37:35,281
META-ANALYSIS IN THE JOURNAL OF

1116
00:37:35,281 --> 00:37:37,083
WOMEN'S HEALTH, 27 STUDIES

1117
00:37:37,083 --> 00:37:38,951
LOOKING AT SCREENING RATES

1118
00:37:38,951 --> 00:37:39,885
POSTPARTUM, AND FOUND ACTUALLY

1119
00:37:39,885 --> 00:37:43,122
WHITE AND BLACK PATIENTS HAVE

1120
00:37:43,122 --> 00:37:44,657
THE LOWEST RATES, ABYSMAL.

1121
00:37:44,657 --> 00:37:46,192
ONLY A THIRD ARE GETTING

1122
00:37:46,192 --> 00:37:47,593
SCREENING FOR DIABETES IN THAT

1123
00:37:47,593 --> 00:37:48,394
FOLLOW-UP PERIOD, EVEN THOUGH WE

1124
00:37:48,394 --> 00:37:50,997
KNOW THIS IS THE HIGHEST RISK

1125
00:37:50,997 --> 00:37:51,864
GROUP.

1126
00:37:51,864 --> 00:37:52,732
IT'S ABYSMAL FOR EVERYBODY, 50%

1127
00:37:52,732 --> 00:37:53,699
OR LOWER.

1128
00:37:53,699 --> 00:37:56,235
BUT THE POINT IS THAT AMONG GDM

1129
00:37:56,235 --> 00:37:57,903
PATIENTS WE HAVE SCREENING

1130
00:37:57,903 --> 00:38:00,306
DEFICIT AMONG WHITE AND BLACK

1131
00:38:00,306 --> 00:38:00,873
PATIENTS, OVERALL GENERAL

1132
00:38:00,873 --> 00:38:03,042
POPULATION IT TENDS TO BE AMONG

1133
00:38:03,042 --> 00:38:03,909
ASIAN PATIENTS SO DEPENDS IN

1134
00:38:03,909 --> 00:38:05,444
TERMS OF THE GROUP YOU'RE

1135
00:38:05,444 --> 00:38:07,647
LOOKING AT.

1136
00:38:07,647 --> 00:38:08,981
AND WE'LL TALK MORE ABOUT

1137
00:38:08,981 --> 00:38:10,283
THOUGHTS HOW TO IMPROVE

1138
00:38:10,283 --> 00:38:12,985
SCREENING RATES TOWARDS THE END.

1139
00:38:12,985 --> 00:38:14,654
SO I'VE BEEN MENTIONING EARLIER

1140
00:38:14,654 --> 00:38:17,256
THAT BECAUSE OF THE DPP TRIAL,

1141
00:38:17,256 --> 00:38:20,559
IT WAS JUMPED ON, AND THERE WAS

1142
00:38:20,559 --> 00:38:21,994
SOMETHING INSTITUTED CALLED

1143
00:38:21,994 --> 00:38:23,529
NATIONAL DIABETES PREVENTION

1144
00:38:23,529 --> 00:38:24,697
PROGRAM, NATIONAL DPP.

1145
00:38:24,697 --> 00:38:26,599
THIS WAS AUTHORIZED BY CONGRESS,

1146
00:38:26,599 --> 00:38:29,735
TOOK ABOUT 8 YEARS AFTER THAT

1147
00:38:29,735 --> 00:38:29,935
PAPER.

1148
00:38:29,935 --> 00:38:31,370
AUTHORIZED IN 2010, WITH REALLY

1149
00:38:31,370 --> 00:38:33,439
THE GOAL OF TRANSLATING THAT

1150
00:38:33,439 --> 00:38:39,045
PAPER TO REDUCE U.S. DIABETES

1151
00:38:39,045 --> 00:38:39,578
INCIDENCE.

1152
00:38:39,578 --> 00:38:45,184
TO BEND THE CURVE DECREASE NEW

1153
00:38:45,184 --> 00:38:47,586
CASES AND THEREFORE

1154
00:38:47,586 --> 00:38:48,154
COMPLICATIONS.

1155
00:38:48,154 --> 00:38:49,221
THE CDC WAS GIVEN THE MANDATE

1156
00:38:49,221 --> 00:38:51,824
AND DID A GREAT JOB.

1157
00:38:51,824 --> 00:38:54,493
THEY RECOGNIZE SUPPLIERS IN THE

1158
00:38:54,493 --> 00:38:55,261
COMMUNITY OFFERING DPP,

1159
00:38:55,261 --> 00:38:56,996
SUPPLIERS HAVE TO USE COMMON

1160
00:38:56,996 --> 00:38:58,431
CURRICULUM EVIDENCE-BASED, YOU

1161
00:38:58,431 --> 00:38:59,198
CAN MAKE SOME MODIFICATIONS BUT

1162
00:38:59,198 --> 00:39:01,600
YOU HAVE TO KEEP THE CORE OF IT.

1163
00:39:01,600 --> 00:39:03,436
THESE PROGRAMS ALSO HAVE TO

1164
00:39:03,436 --> 00:39:04,337
ACHIEVE ACCEPTABLE OUTCOMES.

1165
00:39:04,337 --> 00:39:06,672
THEY ALL HAVE TO SEND IN THE

1166
00:39:06,672 --> 00:39:08,374
RESULTS OF COHORTS IN TERMS OF

1167
00:39:08,374 --> 00:39:10,476
WEIGHT LOSS AND ACTIVITY CHANGE,

1168
00:39:10,476 --> 00:39:11,544
TO THE CDC.

1169
00:39:11,544 --> 00:39:14,447
AND IF NOT ACHIEVING ACCEPTABLE

1170
00:39:14,447 --> 00:39:15,948
RESULTS GET A PROBATION PERIOD

1171
00:39:15,948 --> 00:39:17,783
WHERE THE CDC WORKS WITH THEM,

1172
00:39:17,783 --> 00:39:19,752
IF NOT HITTING IT THEY LOSE

1173
00:39:19,752 --> 00:39:21,420
THEIR RECOGNITION BECAUSE

1174
00:39:21,420 --> 00:39:23,489
CORRECTED WANTS TO MAKE SURE YOU

1175
00:39:23,489 --> 00:39:26,425
CAN'T JUST PUT UP A SHINGLE AND

1176
00:39:26,425 --> 00:39:27,960
SAY YOU'RE DOING DPP AND NOT GET

1177
00:39:27,960 --> 00:39:29,261
RESULTS WE THINK YOU SHOULD.

1178
00:39:29,261 --> 00:39:30,763
THE ORIGINAL TRIAL LIKE I

1179
00:39:30,763 --> 00:39:32,598
REMEMBER WAS ONE ON ONE, AND IT

1180
00:39:32,598 --> 00:39:38,037
WAS REALIZED THAT WE JUST CAN'T

1181
00:39:38,037 --> 00:39:40,039
AFFORD ONE-ON-ONE SESSIONS FOR

1182
00:39:40,039 --> 00:39:40,373
AMERICA.

1183
00:39:40,373 --> 00:39:42,675
SO, THE CDC HAS AUTHORIZED GROUP

1184
00:39:42,675 --> 00:39:44,276
SESSIONS AS PART OF THIS.

1185
00:39:44,276 --> 00:39:45,611
AND THEY VARY A LOT.

1186
00:39:45,611 --> 00:39:48,147
THE AREA WE TEND TO STUDY I

1187
00:39:48,147 --> 00:39:50,783
THINK IN PERSON, THEY TEND TO BE

1188
00:39:50,783 --> 00:39:52,752
ONE LIFESTYLE COACH FOR MAYBE

1189
00:39:52,752 --> 00:39:54,186
SIX OR EIGHT PEOPLE.

1190
00:39:54,186 --> 00:39:55,154
BUT THERE ARE A LOT OF PRIVATE

1191
00:39:55,154 --> 00:39:57,656
COMPANIES IN THE MARKET NOW,

1192
00:39:57,656 --> 00:39:58,958
OFFERING VIRTUAL DPP WHICH HAS

1193
00:39:58,958 --> 00:40:00,393
BENEFITS BUT ALSO DOWN SIDES.

1194
00:40:00,393 --> 00:40:04,463
ONE OF WHICH IS SOME COMPANIES

1195
00:40:04,463 --> 00:40:08,968
HAVE 1:100 RATIOS ONLINE, SOME

1196
00:40:08,968 --> 00:40:11,804
ARE ASYNCHRONOUS, HARD TO REACH

1197
00:40:11,804 --> 00:40:13,339
THE COACH, GREAT DEBATE HOW

1198
00:40:13,339 --> 00:40:14,874
EFFECTIVE THESE ARE.

1199
00:40:14,874 --> 00:40:17,176
PART OF A FUNDED NETWORK LOOKING

1200
00:40:17,176 --> 00:40:18,811
AT NATIONAL DPP IN THE REAL

1201
00:40:18,811 --> 00:40:21,213
WORLD LOOKING AT ARE VIRTUAL

1202
00:40:21,213 --> 00:40:22,848
PROGRAM AS EFFECTS AS IN-PERSON

1203
00:40:22,848 --> 00:40:24,617
PROGRAMS?  WHAT'S THE COST

1204
00:40:24,617 --> 00:40:26,018
EFFECTIVENESS, WHAT ARE BENEFITS

1205
00:40:26,018 --> 00:40:27,253
ON OTHER OUTCOMES?

1206
00:40:27,253 --> 00:40:28,487
BLOOD PRESSURE, FOR EXAMPLE,

1207
00:40:28,487 --> 00:40:29,889
LIPID CHANGE.

1208
00:40:29,889 --> 00:40:31,390
THIS KIND OF THING.

1209
00:40:31,390 --> 00:40:32,358
TO DO A COMPREHENSIVE EVALUATION

1210
00:40:32,358 --> 00:40:34,794
HOW THIS IS WORKING IN THE REAL

1211
00:40:34,794 --> 00:40:35,094
WORLD.

1212
00:40:35,094 --> 00:40:36,662
AND THE OTHER MODIFICATION IS

1213
00:40:36,662 --> 00:40:39,832
LIKE I MENTIONED YOU HAD TO HAVE

1214
00:40:39,832 --> 00:40:41,267
PREDIABETES IN THE RCT BUT HERE

1215
00:40:41,267 --> 00:40:43,969
AGAIN TO EXPAND IT YOU COULD

1216
00:40:43,969 --> 00:40:45,438
MAKE IT WITH THE QUALIFYING RISK

1217
00:40:45,438 --> 00:40:47,506
SCORE, IN THE U.S. ANYWAY, WHERE

1218
00:40:47,506 --> 00:40:50,976
IF YOU HAD ENOUGH RISK FACTORS,

1219
00:40:50,976 --> 00:40:52,845
FAMILY HISTORY, GESTATIONAL

1220
00:40:52,845 --> 00:40:54,180
DIABETES, HYPERTENSION, MALE

1221
00:40:54,180 --> 00:40:56,582
GENDER, YOU COULD GET IN AND

1222
00:40:56,582 --> 00:40:56,916
QUALIFY.

1223
00:40:56,916 --> 00:41:00,519
AND AS OF 2019, IT'S GONE UP

1224
00:41:00,519 --> 00:41:01,520
SINCE THEN, MORE THAN 300,000

1225
00:41:01,520 --> 00:41:03,022
PEOPLE PASSED THROUGH THE

1226
00:41:03,022 --> 00:41:03,389
PROGRAM.

1227
00:41:03,389 --> 00:41:05,658
IT'S STILL A LITTLE BIT OF DROP

1228
00:41:05,658 --> 00:41:07,226
IN THE BUCKET BUT I THINK WE'RE

1229
00:41:07,226 --> 00:41:11,831
TRYING  OUR BEST TO IMPROVE IT.

1230
00:41:11,831 --> 00:41:13,666
WE HAVEN'T LOOKED ENOUGH AT HOW

1231
00:41:13,666 --> 00:41:16,302
WELL IT'S WORKING FOR DIFFERENT

1232
00:41:16,302 --> 00:41:18,070
RACIAL AND ETHNIC GROUPS, WHAT

1233
00:41:18,070 --> 00:41:19,205
I'LL BE TALKING ABOUT SHORTLY.

1234
00:41:19,205 --> 00:41:21,140
I THINK IT'S ONE THING TO HAVE

1235
00:41:21,140 --> 00:41:22,441
AN OVERALL EFFECT, ANOTHER THING

1236
00:41:22,441 --> 00:41:24,410
ALTOGETHER TO MAKE SURE WE'RE

1237
00:41:24,410 --> 00:41:26,712
REACHING PEOPLE OF COLOR,

1238
00:41:26,712 --> 00:41:27,880
PARTICULARLY BECAUSE AS WE SAW

1239
00:41:27,880 --> 00:41:31,684
IN THE RCT IN THE TIGHT

1240
00:41:31,684 --> 00:41:32,284
ENVIRONMENT, DOES THAT

1241
00:41:32,284 --> 00:41:32,751
TRANSLATE.

1242
00:41:32,751 --> 00:41:33,919
SO, THESE ARE THE RESULTS I

1243
00:41:33,919 --> 00:41:36,222
SHOWED BEFORE FROM THE RCT, AS

1244
00:41:36,222 --> 00:41:37,990
YOU REMEMBER JUST TERRIFIC.

1245
00:41:37,990 --> 00:41:40,159
EVEN BETTER FOR PERSONS OF

1246
00:41:40,159 --> 00:41:40,526
COLOR.

1247
00:41:40,526 --> 00:41:41,894
THESE ARE RESULTS FROM THE

1248
00:41:41,894 --> 00:41:44,797
TRANSLATION INTO THE REAL WORLD

1249
00:41:44,797 --> 00:41:45,464
THROUGH NATIONAL DPP.

1250
00:41:45,464 --> 00:41:47,566
SO, THIS WAS 2017.

1251
00:41:47,566 --> 00:41:48,667
I HAVEN'T SEEN UPDATED RESULTS

1252
00:41:48,667 --> 00:41:49,668
SINCE THEN BUT I DON'T THINK

1253
00:41:49,668 --> 00:41:50,970
IT'S CHANGED THAT MUCH.

1254
00:41:50,970 --> 00:41:52,805
SO A COUPLE THINGS TO NOTE.

1255
00:41:52,805 --> 00:41:54,540
ONE IS CDC IN THE TRANSLATION

1256
00:41:54,540 --> 00:41:56,308
KIND OF BACKED OFF THE WEIGHT

1257
00:41:56,308 --> 00:41:57,643
LOSS GOAL.

1258
00:41:57,643 --> 00:41:59,612
NOTHING IS EFFECTIVE AS RCT SO

1259
00:41:59,612 --> 00:42:01,914
REALIZED WE CAN SHOOT FOR 5%,

1260
00:42:01,914 --> 00:42:03,382
WHICH IS STILL VERY IMPORTANT

1261
00:42:03,382 --> 00:42:03,983
AND EFFECTIVE.

1262
00:42:03,983 --> 00:42:05,851
AS YOU CAN SEE WHEN YOU TAKE IT

1263
00:42:05,851 --> 00:42:10,122
TO THE REAL WORLD, BENEFITS FOR

1264
00:42:10,122 --> 00:42:11,757
PEOPLE OF COLOR VANISH.

1265
00:42:11,757 --> 00:42:13,726
YOU HAVE HIGHEST RATE OF WHITE

1266
00:42:13,726 --> 00:42:15,895
PATIENTS ACHIEVING WEIGHT LOSS

1267
00:42:15,895 --> 00:42:20,933
GOAL OF 43%, DROPS TO 27% BLACK

1268
00:42:20,933 --> 00:42:22,701
PATIENTS, 31% FOR LATINO

1269
00:42:22,701 --> 00:42:22,968
PATIENTS.

1270
00:42:22,968 --> 00:42:26,839
THIS IS NOT DIABETES INCIDENCE,

1271
00:42:26,839 --> 00:42:32,011
GOLD STANDARD BUT THESE ARE 

1272
00:42:32,011 --> 00:42:32,678
CLOSELY LINKED, SURROGATE

1273
00:42:32,678 --> 00:42:34,313
OUTCOME CONCERNING TO MANY OF

1274
00:42:34,313 --> 00:42:34,480
US.

1275
00:42:34,480 --> 00:42:36,081
PART OF THE REASON WHY WE'RE NOT

1276
00:42:36,081 --> 00:42:37,850
SEEING THE WEIGHT LOSS IN BLACK

1277
00:42:37,850 --> 00:42:39,919
LATINO PATIENTS IS BECAUSE OF

1278
00:42:39,919 --> 00:42:40,886
LOWER PROGRAM RETENTION.

1279
00:42:40,886 --> 00:42:42,755
YOU MIGHT HAVE BEEN THINKING TO

1280
00:42:42,755 --> 00:42:43,656
YOUR SATISFY YEAR-LONG PROGRAM

1281
00:42:43,656 --> 00:42:46,692
IS A LOT TO COMMIT TO, ALL OF US

1282
00:42:46,692 --> 00:42:48,260
ARE BUSY, TO TALK ABOUT 16

1283
00:42:48,260 --> 00:42:48,561
WEEKS.

1284
00:42:48,561 --> 00:42:49,762
EIGHT MORE SESSIONS.

1285
00:42:49,762 --> 00:42:51,430
HOW MANY PEOPLE ACTUALLY STICK

1286
00:42:51,430 --> 00:42:52,965
WITH IT OVER TIME?

1287
00:42:52,965 --> 00:42:54,400
AND THE ANSWER IS MORE WHITE

1288
00:42:54,400 --> 00:42:58,103
PEOPLE THAN PEOPLE FROM OTHER

1289
00:42:58,103 --> 00:42:59,104
RACIAL/ETHNIC GROUPS.

1290
00:42:59,104 --> 00:43:02,041
RETENTION AT WEEK 18 IS 71% OF

1291
00:43:02,041 --> 00:43:05,778
WHITE PARTICIPANTS, DROPS TO 61%

1292
00:43:05,778 --> 00:43:08,948
FOR BLACK PARTICIPANTS, 53% FOR

1293
00:43:08,948 --> 00:43:09,381
LATINO PARTICIPANTS.

1294
00:43:09,381 --> 00:43:11,383
WE'LL TALK ABOUT THAT IN THE

1295
00:43:11,383 --> 00:43:13,419
NEXT SLIDE.

1296
00:43:13,419 --> 00:43:15,421
THIS IS FROM THE SAME 2017

1297
00:43:15,421 --> 00:43:17,923
DESCRIPTIVE EVALUATION OF THE

1298
00:43:17,923 --> 00:43:18,757
NATIONAL DPP, AND VERY CLEAR

1299
00:43:18,757 --> 00:43:20,326
STRONG DATA THAT THE MORE YOU

1300
00:43:20,326 --> 00:43:22,528
ATTEND, THE MORE YOU LOSE

1301
00:43:22,528 --> 00:43:22,761
WEIGHT.

1302
00:43:22,761 --> 00:43:26,265
SO, THE X-AXIS IS THE MEDIAN

1303
00:43:26,265 --> 00:43:27,666
PERCENT WEIGHT CHANGE.

1304
00:43:27,666 --> 00:43:29,435
CDC GOAL, I NOTED CDC GOAL IS

1305
00:43:29,435 --> 00:43:31,203
5%, WHICH IS THE BOLD VERTICAL

1306
00:43:31,203 --> 00:43:34,673
LINE IN THE MIDDLE.

1307
00:43:34,673 --> 00:43:36,709
AND ON THE Y-AXIS IS NUMBER OF

1308
00:43:36,709 --> 00:43:39,912
SESSIONS ATTENDED, ONE AT THE

1309
00:43:39,912 --> 00:43:40,913
TOP GOING DOWN, 29.

1310
00:43:40,913 --> 00:43:42,348
IF YOU ATTEND ONE SESSION YOU'RE

1311
00:43:42,348 --> 00:43:42,915
NOT DOING GREAT.

1312
00:43:42,915 --> 00:43:45,217
IF YOU GET TO FIVE THAT'S

1313
00:43:45,217 --> 00:43:45,517
BETTER.

1314
00:43:45,517 --> 00:43:46,285
NINE IS BETTER.

1315
00:43:46,285 --> 00:43:47,620
15 IS BETTER.

1316
00:43:47,620 --> 00:43:51,824
ONCE YOU HIT AROUND 19 SESSIONS,

1317
00:43:51,824 --> 00:43:53,525
YOU LOSE 5% OF WEIGHT.

1318
00:43:53,525 --> 00:43:54,927
WE KNOW IF YOU'RE NOT RETAINING

1319
00:43:54,927 --> 00:43:56,495
IN THE PROGRAM AND DROPPING OUT

1320
00:43:56,495 --> 00:43:58,797
EARLIER YOU'RE LOSING NO WEIGHT,

1321
00:43:58,797 --> 00:44:02,167
OR 1% OR 1 1/2%, NOT HITTING

1322
00:44:02,167 --> 00:44:04,570
GOALS WE'D LIKE.

1323
00:44:04,570 --> 00:44:05,838
OUR TEAM DID INTERVIEWS TO

1324
00:44:05,838 --> 00:44:07,439
FIGURE OUT WHY BLACK AND LATINO

1325
00:44:07,439 --> 00:44:08,641
PATIENTS ARE LEAVING EARLY AND

1326
00:44:08,641 --> 00:44:10,376
NOT LOSING WEIGHT.

1327
00:44:10,376 --> 00:44:15,180
COMES DOWN TO SOCIAL

1328
00:44:15,180 --> 00:44:15,648
DETERMINANTS.

1329
00:44:15,648 --> 00:44:17,282
PEOPLE HAD HOW LONGER JOBS THEY

1330
00:44:17,282 --> 00:44:18,350
COULDN'T MISS.

1331
00:44:18,350 --> 00:44:19,685
PEOPLE ON SALARY JOBS, IT'S

1332
00:44:19,685 --> 00:44:21,420
EASIER TO CARVE OUT TIME TO GET

1333
00:44:21,420 --> 00:44:23,522
TO THE PROGRAM, EITHER IN PERSON

1334
00:44:23,522 --> 00:44:24,723
OR ONLINE.

1335
00:44:24,723 --> 00:44:26,358
IF YOU WORK HOURLY YOU JUST

1336
00:44:26,358 --> 00:44:27,760
CAN'T DO THAT, CAN'T TELL YOUR

1337
00:44:27,760 --> 00:44:28,994
BOSS I NEED TO TAKE A BREAK

1338
00:44:28,994 --> 00:44:32,164
DURING THE DAY TO JOIN THE DPP.

1339
00:44:32,164 --> 00:44:34,333
ANOTHER BIG ISSUE IS

1340
00:44:34,333 --> 00:44:35,334
TRANSPORTATION AMONG BLACK AND

1341
00:44:35,334 --> 00:44:36,969
LATINO PATIENTS.

1342
00:44:36,969 --> 00:44:39,371
IT MAY BE HARDER TO GET TO THE

1343
00:44:39,371 --> 00:44:41,340
DPP, BECAUSE THE DPP IS NOT

1344
00:44:41,340 --> 00:44:42,241
NECESSARILY IN NEIGHBORHOODS

1345
00:44:42,241 --> 00:44:42,875
WHERE THEY LIVE.

1346
00:44:42,875 --> 00:44:44,710
IF YOU HAVE TO CATCH A COUPLE

1347
00:44:44,710 --> 00:44:46,912
BUSES AND TRANSFER YOU MIGHT DO

1348
00:44:46,912 --> 00:44:49,214
THAT AT SESSION 1, AND BY

1349
00:44:49,214 --> 00:44:50,883
SESSION 6 YOUR MOTIVATION WANES

1350
00:44:50,883 --> 00:44:52,418
AND YOU STOP JOINING, STOP

1351
00:44:52,418 --> 00:44:52,685
ATTENDING.

1352
00:44:52,685 --> 00:44:53,852
THERE ARE OTHER REASONS WE FOUND

1353
00:44:53,852 --> 00:44:56,455
AS WELL BUT REALLY IT COMES DOWN

1354
00:44:56,455 --> 00:44:57,122
TO SOCIAL REASONS.

1355
00:44:57,122 --> 00:44:59,391
I THINK THAT IS WHERE WE NEED TO

1356
00:44:59,391 --> 00:45:01,060
TACKLE THIS, AND I'LL TALK ABOUT

1357
00:45:01,060 --> 00:45:03,028
SOME THINGS WE'RE DOING, SOME

1358
00:45:03,028 --> 00:45:04,797
THINGS SHOWN TO WORK TO

1359
00:45:04,797 --> 00:45:05,664
ESSENTIALLY KEEP BLACK AND

1360
00:45:05,664 --> 00:45:07,433
LATINO PATIENTS IN THE PROGRAM

1361
00:45:07,433 --> 00:45:09,835
FOR LONGER TO HELP THEM HIT THAT

1362
00:45:09,835 --> 00:45:11,403
5% WEIGHT LOSS TARGET OR AT

1363
00:45:11,403 --> 00:45:13,372
LEAST LOSE MORE WEIGHT AND

1364
00:45:13,372 --> 00:45:15,107
THEREFORE MAKE THIS MORE

1365
00:45:15,107 --> 00:45:17,776
EQUITABLE AS A NATIONAL PROGRAM.

1366
00:45:17,776 --> 00:45:20,045
BY THE WAY, U.S. IS NOT THE ONLY

1367
00:45:20,045 --> 00:45:23,315
COUNTRY IN THIS SPACE.

1368
00:45:23,315 --> 00:45:24,983
THE U.K. INSTITUTED WHAT THEY

1369
00:45:24,983 --> 00:45:26,885
HOPE IS A NATIONWIDE DIABETES

1370
00:45:26,885 --> 00:45:27,853
PREVENTION PROGRAM THERE.

1371
00:45:27,853 --> 00:45:30,055
OF COURSE, SAME OBESITY PROBLEM

1372
00:45:30,055 --> 00:45:32,257
WE HAVE HERE IS THERE IN THE

1373
00:45:32,257 --> 00:45:32,524
U.K.

1374
00:45:32,524 --> 00:45:33,592
A FEW DIFFERENCES.

1375
00:45:33,592 --> 00:45:37,296
ONE IS IT'S MODELED ON THE U.S.

1376
00:45:37,296 --> 00:45:42,901
DPP, BUT 18 SESSIONS ARE A LOT,

1377
00:45:42,901 --> 00:45:44,303
18+, THEY LIMIT TO 13 SESSIONS

1378
00:45:44,303 --> 00:45:45,938
OVER NINE MONTHS.

1379
00:45:45,938 --> 00:45:46,805
SO FEWER SESSIONS, SHORTER

1380
00:45:46,805 --> 00:45:49,241
PERIOD OF TIME.

1381
00:45:49,241 --> 00:45:50,776
NATIONWIDE ROLLOUT IN 2016, AND

1382
00:45:50,776 --> 00:45:51,844
SO THE FIRST EVALUATION PAPER

1383
00:45:51,844 --> 00:45:54,146
THAT I SAW CAME OUT ON THE LAST

1384
00:45:54,146 --> 00:45:56,014
MONTH OR TWO.

1385
00:45:56,014 --> 00:45:58,751
JUST TO NOTE THAT IT'S EASIER TO

1386
00:45:58,751 --> 00:46:00,619
ANALYZE THIS ONE BECAUSE

1387
00:46:00,619 --> 00:46:02,788
ENROLLMENT WAS STRICTLY LIMITED

1388
00:46:02,788 --> 00:46:03,989
TO PATIENTS WITH PREDIABETES, NO

1389
00:46:03,989 --> 00:46:06,625
RISK SCORES, SUCH THAT THERE'S A

1390
00:46:06,625 --> 00:46:07,025
CUTOFF.

1391
00:46:07,025 --> 00:46:09,361
IF YOUR LEVEL IS ABOVE A CERTAIN

1392
00:46:09,361 --> 00:46:11,130
A1c YOU GET IN, IF IT'S RIGHT

1393
00:46:11,130 --> 00:46:13,198
BELOW YOU DON'T GET IN.

1394
00:46:13,198 --> 00:46:16,034
AND THOSE TWO GROUPS DON'T

1395
00:46:16,034 --> 00:46:18,670
DIFFER IN MUCH BESIDES SLIGHT

1396
00:46:18,670 --> 00:46:21,840
A1c VARIATION.

1397
00:46:21,840 --> 00:46:23,342
YOU CAN USE REGRESSION

1398
00:46:23,342 --> 00:46:24,243
DISCONTINUITY DESIGN,

1399
00:46:24,243 --> 00:46:24,743
EXPERIMENTAL APPROACH TO

1400
00:46:24,743 --> 00:46:25,477
EVALUATE THE PROGRAM.

1401
00:46:25,477 --> 00:46:27,446
THAT IS WHAT THE INVESTIGATORS

1402
00:46:27,446 --> 00:46:27,613
DID.

1403
00:46:27,613 --> 00:46:30,182
AND THEY HAVE A VERY LONG PAPER

1404
00:46:30,182 --> 00:46:31,683
LOOKING AT OVERALL WEIGHT LOSS,

1405
00:46:31,683 --> 00:46:34,353
IF YOU DIG DEEP IN SUPPLEMENTARY

1406
00:46:34,353 --> 00:46:35,621
MATERIAL THIS IS WHAT YOU FIND,

1407
00:46:35,621 --> 00:46:37,656
WAY BACK IN THE SUPPLEMENTAL

1408
00:46:37,656 --> 00:46:39,858
TAPES, BREAK DOWN IN WEIGHT LOSS

1409
00:46:39,858 --> 00:46:40,926
BY RACE AND ETHNICITY.

1410
00:46:40,926 --> 00:46:44,196
SO YOU CAN SEE IN THE U.K. WHAT

1411
00:46:44,196 --> 00:46:46,732
THEY FOUND WAS WEIGHT LOSS IS

1412
00:46:46,732 --> 00:46:48,033
GREATEST AMONG WHITE

1413
00:46:48,033 --> 00:46:49,134
INDIVIDUALS, ACTUALLY PRETTY

1414
00:46:49,134 --> 00:46:50,435
GOOD AMONG BLACK INDIVIDUALS IN

1415
00:46:50,435 --> 00:46:52,771
THE U.K.

1416
00:46:52,771 --> 00:46:55,607
AND REALLY ABYSMAL AMONG PEOPLE

1417
00:46:55,607 --> 00:46:57,042
OF ASIAN DESCENT.

1418
00:46:57,042 --> 00:46:59,344
IF YOU KNOW THE U.K. WELL THIS

1419
00:46:59,344 --> 00:47:05,117
IS NOT SURPRISING BECAUSE THERE,

1420
00:47:05,117 --> 00:47:07,085
SOME ASIAN GROUPS FACE MORE

1421
00:47:07,085 --> 00:47:09,154
ADVERSE DETERMINANTS THAN BLACK

1422
00:47:09,154 --> 00:47:10,722
INDIVIDUALS, PEOPLE PARTICULARLY

1423
00:47:10,722 --> 00:47:12,558
WITH ORIGIN IN BANGLADESH AND

1424
00:47:12,558 --> 00:47:12,891
PAKISTAN.

1425
00:47:12,891 --> 00:47:13,859
ALL THESE PARTICIPATION NUMBERS,

1426
00:47:13,859 --> 00:47:15,828
WEIGHT LOSS NUMBERS, COME DOWN

1427
00:47:15,828 --> 00:47:17,029
TO SOCIAL DETERMINANTS AND WHAT

1428
00:47:17,029 --> 00:47:19,331
THESE GROUPS FACE IN TERMS OF

1429
00:47:19,331 --> 00:47:20,499
ADVERSE CONDITIONS IN THEIR

1430
00:47:20,499 --> 00:47:23,268
ENVIRONMENTS, BE IT IN THE U.S.

1431
00:47:23,268 --> 00:47:25,571
OR IN THE U.K.

1432
00:47:25,571 --> 00:47:26,672
ALL RIGHT.

1433
00:47:26,672 --> 00:47:28,740
THIS IS THE LAST SECTION.

1434
00:47:28,740 --> 00:47:31,476
AND LET ME LOOK AT THE TIME.

1435
00:47:31,476 --> 00:47:33,011
I'LL FINISH UP CERTAINLY BY

1436
00:47:33,011 --> 00:47:39,885
12:00 AND LOOKING FORWARD TO

1437
00:47:39,885 --> 00:47:40,219
DISCUSSION.

1438
00:47:40,219 --> 00:47:42,087
HOW CAN WE REDUCE DISPARITIES IN

1439
00:47:42,087 --> 00:47:43,188
DIABETES SCREENING AND

1440
00:47:43,188 --> 00:47:43,722
PREVENTION?

1441
00:47:43,722 --> 00:47:47,759
ONE THING TO CONSIDER RACE-BASED

1442
00:47:47,759 --> 00:47:49,494
BMI CUTOFF FOR DIABETES

1443
00:47:49,494 --> 00:47:49,828
SCREENING.

1444
00:47:49,828 --> 00:47:51,296
WE KNOW SCREENING RATES ARE

1445
00:47:51,296 --> 00:47:55,868
LOWER  FOR ASIAN AMERICANS.

1446
00:47:55,868 --> 00:48:02,007
THIS IS A STUDY FROM 2022 USING

1447
00:48:02,007 --> 00:48:02,875
NHANES DATA LOOKING BY WEIGHT.

1448
00:48:02,875 --> 00:48:05,510
ON THE LEFT IS NORMAL WEIGHT.

1449
00:48:05,510 --> 00:48:07,179
SECOND WITH OVERWEIGHT.

1450
00:48:07,179 --> 00:48:08,046
FOCUS ON THOSE.

1451
00:48:08,046 --> 00:48:11,383
WITHIN EACH THERE'S FIVE BARS,

1452
00:48:11,383 --> 00:48:13,385
LEFT TO RIGHT WHITE AMERICANS,

1453
00:48:13,385 --> 00:48:15,487
ASIAN AMERICAN, BLACK AMERICAN,

1454
00:48:15,487 --> 00:48:16,788
MEXICAN AMERICAN, OTHER HISPANIC

1455
00:48:16,788 --> 00:48:17,122
AMERICAN.

1456
00:48:17,122 --> 00:48:18,423
WHAT THE RED BAR IS TRYING TO

1457
00:48:18,423 --> 00:48:20,959
SHOW IF YOU LOOK AT THE

1458
00:48:20,959 --> 00:48:22,160
OVERWEIGHT CLUSTER, SECOND ONE,

1459
00:48:22,160 --> 00:48:24,596
THAT RATE OF DIABETES AMONG

1460
00:48:24,596 --> 00:48:26,131
WHITE INDIVIDUALS OVERWEIGHT IS

1461
00:48:26,131 --> 00:48:30,202
ACTUALLY LESS IF YOU GO TO THE

1462
00:48:30,202 --> 00:48:31,403
LEFT, LESS THAN ASIAN, BLACK,

1463
00:48:31,403 --> 00:48:32,537
MEXICAN AMERICAN INDIVIDUALS

1464
00:48:32,537 --> 00:48:34,139
NORMAL WEIGHT.

1465
00:48:34,139 --> 00:48:35,474
SO THOSE PEOPLE NORMAL WEIGHT

1466
00:48:35,474 --> 00:48:36,975
ARE REALLY HAVING HIGHER RATES

1467
00:48:36,975 --> 00:48:38,944
OF DIABETES THAN WHITE PATIENTS

1468
00:48:38,944 --> 00:48:40,045
IN THE OVERWEIGHT.

1469
00:48:40,045 --> 00:48:42,447
AND SO THERE'S A PUSH, AT LEAST

1470
00:48:42,447 --> 00:48:44,750
A PAPER AND DISCUSSION THEY

1471
00:48:44,750 --> 00:48:47,019
SUGGESTED THAT WE CHANGE THE

1472
00:48:47,019 --> 00:48:47,920
THRESHOLDS FOR DIABETES

1473
00:48:47,920 --> 00:48:48,186
SCREENING.

1474
00:48:48,186 --> 00:48:49,755
LIKE I MENTIONED EARLIER RIGHT

1475
00:48:49,755 --> 00:48:53,525
NOW IT'S AT 25+ FOR ALL.

1476
00:48:53,525 --> 00:48:55,160
CONSIDER 23+ FOR ASIANS BUT

1477
00:48:55,160 --> 00:48:57,462
RECOMMENDATIONS IN THIS PAPER

1478
00:48:57,462 --> 00:48:59,364
TALK ABOUT LEAVING THAT CURRENT

1479
00:48:59,364 --> 00:49:01,733
25+ BMI CUTOFF FOR WHITE

1480
00:49:01,733 --> 00:49:03,568
INDIVIDUALS, DROPPING TO 20+ FOR

1481
00:49:03,568 --> 00:49:06,405
ASIAN INDIVIDUALS, AS LOW AS

1482
00:49:06,405 --> 00:49:08,240
18.5 FOR BLACK AND LATINO

1483
00:49:08,240 --> 00:49:08,640
INDIVIDUALS.

1484
00:49:08,640 --> 00:49:11,376
I THINK THIS IS WHAT THEY ARE

1485
00:49:11,376 --> 00:49:12,110
ADVOCATING.

1486
00:49:12,110 --> 00:49:14,313
I THINK ANY RACE-BASED CUTOFFS,

1487
00:49:14,313 --> 00:49:17,382
DEFINITELY THERE'S PROS AND

1488
00:49:17,382 --> 00:49:19,151
CONS, AND IT'S CONTROVERSIAL.

1489
00:49:19,151 --> 00:49:27,159
PROS, , MAY MAXIMIZE

1490
00:49:27,159 --> 00:49:28,660
EFFECTIVENESS AND LEAD TO

1491
00:49:28,660 --> 00:49:31,596
GREATER HEALTH EQUITY.

1492
00:49:31,596 --> 00:49:33,799
CONS, HOPEFULLY I'VE CONVINCED

1493
00:49:33,799 --> 00:49:35,534
YOU THAT RACE CERTAINLY IN

1494
00:49:35,534 --> 00:49:36,335
DIABETES BIOLOGIC CONSTRUCT IS

1495
00:49:36,335 --> 00:49:37,235
NOT THERE.

1496
00:49:37,235 --> 00:49:38,737
THESE DISPARITIES ARE NOT

1497
00:49:38,737 --> 00:49:39,338
BIOLOGIC.

1498
00:49:39,338 --> 00:49:40,706
THEY ARE ALL SOCIAL.

1499
00:49:40,706 --> 00:49:42,474
IF YOU DO RACE-BASED CUTOFFS

1500
00:49:42,474 --> 00:49:43,675
THERE'S A FEAR IT WILL CEMENT IN

1501
00:49:43,675 --> 00:49:45,210
THE MINDS OF PATIENTS AND

1502
00:49:45,210 --> 00:49:47,045
PROVIDERS THAT THERE IS A

1503
00:49:47,045 --> 00:49:48,480
BIOLOGIC CONSTRUCT AND WE WANT

1504
00:49:48,480 --> 00:49:50,215
TO AVOID THAT.

1505
00:49:50,215 --> 00:49:52,184
PRACTICALLY SPEAKING WHAT TO DO

1506
00:49:52,184 --> 00:49:53,986
ABOUT MULTI-RACIAL INDIVIDUALS,

1507
00:49:53,986 --> 00:49:55,053
YOU KNOW, DO YOU SAY HOW WHITE

1508
00:49:55,053 --> 00:49:56,688
ARE YOU, ARE YOU BLACK,

1509
00:49:56,688 --> 00:49:58,223
HISPANIC, HOW DO WE PICK A

1510
00:49:58,223 --> 00:49:58,623
THRESHOLD?

1511
00:49:58,623 --> 00:50:03,028
WHICH I THINK IS GOING TO BE

1512
00:50:03,028 --> 00:50:04,129
VERY DIFFICULT, ONE HANDICAP TO

1513
00:50:04,129 --> 00:50:06,431
THIS APPROACH BUT BEING

1514
00:50:06,431 --> 00:50:07,599
CONSIDERED.

1515
00:50:07,599 --> 00:50:08,266
WHEN THE UPDATED GUIDELINES ARE

1516
00:50:08,266 --> 00:50:09,935
PUT OUT WE'LL SEE IF THEY GO

1517
00:50:09,935 --> 00:50:13,972
DOWN THIS ROUTE OR NOT.

1518
00:50:13,972 --> 00:50:16,174
TO BE DETERMINED.

1519
00:50:16,174 --> 00:50:17,809
SO ANOTHER THING ON THE

1520
00:50:17,809 --> 00:50:18,577
DISPARITIES IN THE PREVENTION

1521
00:50:18,577 --> 00:50:20,645
SIDE IS TRYING TO GET PEOPLE TO

1522
00:50:20,645 --> 00:50:22,714
STICK WITH THE DPP LONGER.

1523
00:50:22,714 --> 00:50:29,087
WE HAVE THE EVIDENCE NOW THAT 

1524
00:50:29,087 --> 00:50:30,422
DIFFERENT IMPLEMENTATION

1525
00:50:30,422 --> 00:50:31,256
STRATEGIES, IMPLEMENTATION CAN

1526
00:50:31,256 --> 00:50:36,495
BOOST DPP  RETENTION.

1527
00:50:36,495 --> 00:50:38,130
THESE ARE SOME THINGS TO GET

1528
00:50:38,130 --> 00:50:39,898
PEOPLE TO STAY.

1529
00:50:39,898 --> 00:50:45,037
FIRST IS MOTIVATIONAL SESSION

1530
00:50:45,037 --> 00:50:46,738
ZERO BEFORE THE FIRST SESSION,

1531
00:50:46,738 --> 00:50:47,606
BRINGING PEOPLE TOGETHER TO TAKE

1532
00:50:47,606 --> 00:50:49,741
MORE TIME TO TALK ABOUT THE

1533
00:50:49,741 --> 00:50:50,742
EVIDENCE BEHIND THE PROGRAM,

1534
00:50:50,742 --> 00:50:53,712
WHAT I TALKED ABOUT TODAY, THE

1535
00:50:53,712 --> 00:50:56,314
EXPECTATIONS WHICH AREN'T THAT

1536
00:50:56,314 --> 00:50:57,182
GREAT, BASICALLY SHOWING UP

1537
00:50:57,182 --> 00:50:59,584
WHICH IS KEY BUT AFTER THAT IT'S

1538
00:50:59,584 --> 00:51:01,887
JUST TALKING ABOUT YOUR DIET OR

1539
00:51:01,887 --> 00:51:03,221
EXERCISE.

1540
00:51:03,221 --> 00:51:04,623
IT SHOULDN'T BE OVERWHELMING, WE

1541
00:51:04,623 --> 00:51:06,725
HOPE, AND I THINK THE THING IS

1542
00:51:06,725 --> 00:51:10,128
TO  CONVINCE PEOPLE.

1543
00:51:10,128 --> 00:51:11,096
THEY HAVE SUCCESSFUL PATIENTS

1544
00:51:11,096 --> 00:51:12,531
COME TO SESSION ZERO WHO SAY I

1545
00:51:12,531 --> 00:51:14,099
WAS JUST LIKE YOU AND I WASN'T

1546
00:51:14,099 --> 00:51:15,400
SURE THIS WOULD WORK FOR ME BUT

1547
00:51:15,400 --> 00:51:17,469
I DID THE PROGRAM AND I LOST THE

1548
00:51:17,469 --> 00:51:20,305
WEIGHT, I FEEL BETTER, SLEEP

1549
00:51:20,305 --> 00:51:21,640
BETTER, MOVE BETTER, AND YOU'VE

1550
00:51:21,640 --> 00:51:22,841
SEEN -- WE'VE SEEN WITH THIS

1551
00:51:22,841 --> 00:51:25,177
KIND OF SESSION ZERO YOU CAN

1552
00:51:25,177 --> 00:51:27,045
KEEP PEOPLE IN FOR UP TO 100

1553
00:51:27,045 --> 00:51:29,881
DAYS LONGER SO REALLY A BIG

1554
00:51:29,881 --> 00:51:30,882
DEAL, SOMETHING THAT SHOULD

1555
00:51:30,882 --> 00:51:32,184
BECOME STANDARD OF CARE.

1556
00:51:32,184 --> 00:51:33,819
IF YOU ATTEND DPP WITH A PARTNER

1557
00:51:33,819 --> 00:51:35,987
THAT KEEPS YOU IN FOR 35 DAYS

1558
00:51:35,987 --> 00:51:38,523
LONGER, WE THINK IT'S THE

1559
00:51:38,523 --> 00:51:39,324
ACCOUNTABILITY TO THAT PERSON

1560
00:51:39,324 --> 00:51:41,026
THAT KEEPS YOU IN.

1561
00:51:41,026 --> 00:51:42,561
IF THERE'S A DIRECT REFERRAL

1562
00:51:42,561 --> 00:51:44,629
FROM YOUR PROVIDER OR YOUR

1563
00:51:44,629 --> 00:51:46,398
DOCTOR THAT KEEPS YOU UP TO 34

1564
00:51:46,398 --> 00:51:48,700
DAYS, A LOT OF PEOPLE GET IN

1565
00:51:48,700 --> 00:51:50,769
THROUGH A HEALTH PLAN.

1566
00:51:50,769 --> 00:51:52,104
HEALTH PLAN FLAGS SUGAR, SENDS

1567
00:51:52,104 --> 00:51:54,639
THEM A LETTER, CALL THIS NUMBER

1568
00:51:54,639 --> 00:51:55,507
FOR THE DPP.

1569
00:51:55,507 --> 00:51:56,475
IF THE DOCTOR EXPLAIN WHY YOU

1570
00:51:56,475 --> 00:51:58,009
SHOULD DO IT AND WHY THEY

1571
00:51:58,009 --> 00:51:59,978
SUPPORT IT, THAT KEEPS PEOPLE

1572
00:51:59,978 --> 00:52:02,147
IN, LIKE I NOTED, FOR 34 DAYS

1573
00:52:02,147 --> 00:52:02,681
LONGER.

1574
00:52:02,681 --> 00:52:04,282
I MENTIONED THE CURRICULUM IS

1575
00:52:04,282 --> 00:52:07,219
EVIDENCE BASED, BUT THERE ARE

1576
00:52:07,219 --> 00:52:13,692
OPPORTUNITIES TO  TAILOR, BASED

1577
00:52:13,692 --> 00:52:17,295
ON GENDER 30 DAYS LONGER AND

1578
00:52:17,295 --> 00:52:19,598
GIVING PEOPLE SWAG, TOTE BAGS

1579
00:52:19,598 --> 00:52:21,533
AND THIS AND THAT, CAN ALSO KEEP

1580
00:52:21,533 --> 00:52:24,302
PEOPLE IN FOR 28 DAYS LONGER.

1581
00:52:24,302 --> 00:52:26,471
PROGRAMS ARE MORE AND MORE

1582
00:52:26,471 --> 00:52:27,672
STARTING TO DO THESE THINGS AS

1583
00:52:27,672 --> 00:52:29,307
WELL AS OTHERS TO PUSH

1584
00:52:29,307 --> 00:52:33,612
RETENTION. 

1585
00:52:33,612 --> 00:52:35,147
THE PROBLEM IS SOME PROGRAMS

1586
00:52:35,147 --> 00:52:37,115
SERVING PATIENTS OF COLOR HAVE

1587
00:52:37,115 --> 00:52:39,417
LESS RESOURCES, MORE DIFFICULT

1588
00:52:39,417 --> 00:52:40,852
TO DO THIS BUT THIS IS WHERE WE

1589
00:52:40,852 --> 00:52:43,922
NEED TO DO TO IMPROVE RETENTION

1590
00:52:43,922 --> 00:52:45,123
AND THERE BY MAKE DIABETES

1591
00:52:45,123 --> 00:52:48,059
PREVENTION WORK THE WAY IT CAN

1592
00:52:48,059 --> 00:52:49,594
FROM THE DPP RCT.

1593
00:52:49,594 --> 00:52:52,998
SO, ANOTHER APPROACH IS SUGAR

1594
00:52:52,998 --> 00:52:53,999
SWEETENED BEVERAGE TAXES.

1595
00:52:53,999 --> 00:52:58,136
MANY OF YOU HAVE FIGURED OUT

1596
00:52:58,136 --> 00:52:59,671
SUGAR SWEETENED BEVERAGE INTAKE

1597
00:52:59,671 --> 00:53:02,407
IS ASSOCIATED, ONE STUDY OF MANY

1598
00:53:02,407 --> 00:53:05,777
ON THIS SLIDE, STUDY OF 50,000

1599
00:53:05,777 --> 00:53:07,546
BLACK WOMEN WHO DID NOT HAVE

1600
00:53:07,546 --> 00:53:08,880
DIABETES, THEY FOLLOWED THEM AND

1601
00:53:08,880 --> 00:53:11,149
WOMEN WHO DRANK TWO OR MORE

1602
00:53:11,149 --> 00:53:13,785
SODAS OF DAY, RISK OF 1.2 HIGHER

1603
00:53:13,785 --> 00:53:15,253
FOR DEVELOPING DIABETES.

1604
00:53:15,253 --> 00:53:17,289
WOMEN WHO DRANK 2 OR MORE

1605
00:53:17,289 --> 00:53:19,257
SERVINGS OF KOOL-AID OR JUICE

1606
00:53:19,257 --> 00:53:20,358
BESIDES ORANGE OR GRAPEFRUIT

1607
00:53:20,358 --> 00:53:23,862
JUICE HAD RELATIVE RISK OF 1.3

1608
00:53:23,862 --> 00:53:25,330
FOR INCIDENT DIABETES.

1609
00:53:25,330 --> 00:53:27,465
THESE BEVERAGES, ALL OVER THE

1610
00:53:27,465 --> 00:53:28,767
PLACE, LEAD TO DIABETES.

1611
00:53:28,767 --> 00:53:31,369
IF YOU RAISE TAXES ON THEM,

1612
00:53:31,369 --> 00:53:34,472
ANALOGOUS TO CIGARETTES, WHAT

1613
00:53:34,472 --> 00:53:34,706
HAPPENS?

1614
00:53:34,706 --> 00:53:38,310
THIS WAS PUBLISHED LAST MONTH

1615
00:53:38,310 --> 00:53:41,613
FROM UCSF, FIVE CITIES, BOTTOM

1616
00:53:41,613 --> 00:53:44,249
LEFT, INSTITUTED SUGAR-SWEETENED

1617
00:53:44,249 --> 00:53:45,684
BEVERAGE TAXES, PHILADELPHIA,

1618
00:53:45,684 --> 00:53:48,353
BOULDER, SAN FRANCISCO, OAKLAND,

1619
00:53:48,353 --> 00:53:48,587
SEATTLE.

1620
00:53:48,587 --> 00:53:51,256
IF YOU CAN GO TO THE RIGHT

1621
00:53:51,256 --> 00:53:52,557
ESSENTIALLY THE GRAYISH-BLUE

1622
00:53:52,557 --> 00:53:53,658
CIRCLE IS THE PRICE CHANGE.

1623
00:53:53,658 --> 00:53:55,827
IT'S IN A PERCENTAGE.

1624
00:53:55,827 --> 00:53:58,363
IF YOU LOOK CITY WITH THE

1625
00:53:58,363 --> 00:54:00,232
HIGHEST TAX, PHILADELPHIA, THEY

1626
00:54:00,232 --> 00:54:02,968
PUT TAXES OF 60% OF THE BASE

1627
00:54:02,968 --> 00:54:04,836
PRICE ON THESE BEVERAGES, IT

1628
00:54:04,836 --> 00:54:09,407
WENT DOWN TO SEATTLE, MORE IN

1629
00:54:09,407 --> 00:54:10,175
THAT LIKE 16-17% RANGE.

1630
00:54:10,175 --> 00:54:12,811
I THINK THE KEY THING TO NOTE IS

1631
00:54:12,811 --> 00:54:14,446
MY COLLEAGUES HAVE SHOWN

1632
00:54:14,446 --> 00:54:17,282
ELEGANTLY THAT WHEN THE TAX IS

1633
00:54:17,282 --> 00:54:20,051
HIGHER, THE VOLUME CHANGED IN

1634
00:54:20,051 --> 00:54:22,020
ORANGE SQUARE, IT'S GREATER, YOU

1635
00:54:22,020 --> 00:54:23,655
HAVE GREATER REDUCTION IN VOLUME

1636
00:54:23,655 --> 00:54:25,857
SOLD BASED ON HIGHER TAX.

1637
00:54:25,857 --> 00:54:28,593
A NICE STEP-WISE PATTERN THERE

1638
00:54:28,593 --> 00:54:31,096
WHERE PHILADELPHIA SOLD LESS OF

1639
00:54:31,096 --> 00:54:32,964
THIS AFTER THE TAX THAN FOR

1640
00:54:32,964 --> 00:54:35,166
EXAMPLE IN SEATTLE WHERE TAX WAS

1641
00:54:35,166 --> 00:54:36,901
SMALLER.

1642
00:54:36,901 --> 00:54:38,536
I'LL SAY MY COLLEAGUES WENT

1643
00:54:38,536 --> 00:54:40,305
DOING PRESS RELEASES WITH THIS

1644
00:54:40,305 --> 00:54:42,941
WORK, THERE'S BEEN TREMENDOUS

1645
00:54:42,941 --> 00:54:44,676
PUSHBACK FROM THE

1646
00:54:44,676 --> 00:54:45,176
SUGAR-SWEETENED BEVERAGE

1647
00:54:45,176 --> 00:54:45,443
COMPANIES.

1648
00:54:45,443 --> 00:54:47,078
COKE IN ATLANTA, THEY RUN

1649
00:54:47,078 --> 00:54:51,249
ATLANTA, THERE'S A COKE MUSEUM,

1650
00:54:51,249 --> 00:54:52,884
PEPSI IS A BEHEMOTH, IT WILL BE

1651
00:54:52,884 --> 00:54:54,085
A LONG PUSH BUT I THINK WE'LL

1652
00:54:54,085 --> 00:54:56,388
GET THERE WHERE WE CAN GET THEM

1653
00:54:56,388 --> 00:54:58,690
TO MAKE MORE HEALTHY BEVERAGES

1654
00:54:58,690 --> 00:55:01,092
AND TAX THE ONES WE KNOW ARE

1655
00:55:01,092 --> 00:55:02,961
LEADING TO DIABETES WHICH IS

1656
00:55:02,961 --> 00:55:04,596
GOING TO ADD POPULATION LEVEL BE

1657
00:55:04,596 --> 00:55:05,664
VERY IMPORTANT I THINK.

1658
00:55:05,664 --> 00:55:07,766
THIS IS THE LAST SLIDE AND I'LL

1659
00:55:07,766 --> 00:55:09,501
MOVE TO A SUMMARY AND LOOKING

1660
00:55:09,501 --> 00:55:10,502
FORWARD TO DISCUSSION ABOUT

1661
00:55:10,502 --> 00:55:12,370
ANYTHING THAT I'VE MENTIONED SO

1662
00:55:12,370 --> 00:55:12,771
FAR.

1663
00:55:12,771 --> 00:55:15,006
IF ANY OF YOU HAVE BEEN TO

1664
00:55:15,006 --> 00:55:16,408
CHICAGO IN THE PAST, OR FROM

1665
00:55:16,408 --> 00:55:17,842
THERE, YOU KNOW THIS BUILDING ON

1666
00:55:17,842 --> 00:55:20,679
THE RIGHT ONE OF THE ROBERT

1667
00:55:20,679 --> 00:55:22,113
TAYLOR HOMES.

1668
00:55:22,113 --> 00:55:23,014
I TRAINED THERE.

1669
00:55:23,014 --> 00:55:24,949
THESE USED TO BE UP AND DOWN THE

1670
00:55:24,949 --> 00:55:28,320
DAN RYAN FREEWAY IN SOUTH

1671
00:55:28,320 --> 00:55:29,120
CHICAGO FOR MILES, THERE'S LIKE

1672
00:55:29,120 --> 00:55:31,623
15 OF THEM.

1673
00:55:31,623 --> 00:55:33,491
THEY WERE KNOCKED DOWN, TENANTS

1674
00:55:33,491 --> 00:55:36,094
HAD THE CHANCE TO MOVE AND THEY

1675
00:55:36,094 --> 00:55:37,862
WERE RANDOMIZED IN INNOVATIVE

1676
00:55:37,862 --> 00:55:38,763
STUDY, MOVING TO OPPORTUNITY,

1677
00:55:38,763 --> 00:55:40,265
THAT YOU'VE HEARD OF.

1678
00:55:40,265 --> 00:55:42,133
ALSO WAS INSTITUTED IN

1679
00:55:42,133 --> 00:55:45,837
BALTIMORE, NEW YORK, LOS

1680
00:55:45,837 --> 00:55:47,238
ANGELES, BOSTON.

1681
00:55:47,238 --> 00:55:51,710
WOMEN WITH CHILDREN RANDOMIZED 

1682
00:55:51,710 --> 00:55:53,445
TO SECTION 8 HOUSING VOUCHERS.

1683
00:55:53,445 --> 00:55:55,313
WHEN I TALK WITH MED STUDENTS

1684
00:55:55,313 --> 00:55:59,084
PEOPLE SAY THIS IS UN ETHICAL,

1685
00:55:59,084 --> 00:56:01,219
HOW CAN YOU RANDOMIZE PEOPLE TO

1686
00:56:01,219 --> 00:56:01,753
HIGH POVERTY AREAS?

1687
00:56:01,753 --> 00:56:03,755
WHEN YOU READ THE PAPERS A LOT

1688
00:56:03,755 --> 00:56:05,056
OF THE RESIDENTS REALLY DID NOT

1689
00:56:05,056 --> 00:56:08,026
WANT TO GO TO LOW POVERTY AREAS

1690
00:56:08,026 --> 00:56:09,661
BECAUSE HONESTLY THOSE ARE

1691
00:56:09,661 --> 00:56:11,196
MOSTLY WHITE AREAS, IN CHICAGO,

1692
00:56:11,196 --> 00:56:12,497
PEOPLE WERE NERVOUS ABOUT THAT,

1693
00:56:12,497 --> 00:56:13,932
REALLY WANTED TO STAY AROUND

1694
00:56:13,932 --> 00:56:16,234
THEIR NETWORKS AND PLACES THEY

1695
00:56:16,234 --> 00:56:16,468
KNEW.

1696
00:56:16,468 --> 00:56:18,203
SO IT WAS A MIXED BAG IN TERMS

1697
00:56:18,203 --> 00:56:22,607
OF WHAT PEOPLE WANTED SO DONE I

1698
00:56:22,607 --> 00:56:25,210
THINK UNDER EQUIPOISE.

1699
00:56:25,210 --> 00:56:27,078
STUDY WAS DONE, AFTER 10-15

1700
00:56:27,078 --> 00:56:29,180
YEARS THEY WERE FOLLOWED, AMONG

1701
00:56:29,180 --> 00:56:32,050
FAMILIES RANDOMIZED TO LOW

1702
00:56:32,050 --> 00:56:33,351
POVERTY AREA REDUCTION IN

1703
00:56:33,351 --> 00:56:35,653
DIABETES INCIDENCE OF 22% AND

1704
00:56:35,653 --> 00:56:36,821
OBESITY INCIDENCE OF 13%.

1705
00:56:36,821 --> 00:56:39,257
THIS GOES TO SAY WHEN YOU HAVE,

1706
00:56:39,257 --> 00:56:41,426
YOU KNOW, BUILT ENVIRONMENT WITH

1707
00:56:41,426 --> 00:56:46,798
LESS FAST FOOD, YOU HAVE MORE

1708
00:56:46,798 --> 00:56:47,766
NEIGHBORHOOD SOCIAL COHESION,

1709
00:56:47,766 --> 00:56:49,534
BASICALLY ALL THESE THINGS, CAN

1710
00:56:49,534 --> 00:56:51,202
YOU PREVENT DIABETES, PREVENT

1711
00:56:51,202 --> 00:56:52,337
OBESITY AND DIABETES.

1712
00:56:52,337 --> 00:56:53,805
THAT OF COURSE NUMBER ONE WE

1713
00:56:53,805 --> 00:56:55,573
NEED MORE STUDIES LIKE THIS.

1714
00:56:55,573 --> 00:56:56,908
THIS IS FROM 2007, I'M JUST

1715
00:56:56,908 --> 00:56:59,511
HAPPY TO SEE MORE AND MORE

1716
00:56:59,511 --> 00:57:00,845
FUNDING OPPORTUNITIES FROM NIH

1717
00:57:00,845 --> 00:57:01,946
LOOKING AT WORKING WITH

1718
00:57:01,946 --> 00:57:03,681
COMMUNITIES, FOR EXAMPLE, TO TRY

1719
00:57:03,681 --> 00:57:05,116
TO GET MOTHER LANDLORDS TO TAKE

1720
00:57:05,116 --> 00:57:06,117
SECTION 8 HOUSING VOUCHERS AND

1721
00:57:06,117 --> 00:57:09,154
DO THE THINGS WE NEED TO DO, TO

1722
00:57:09,154 --> 00:57:10,355
CHANGE DETERMINANTS, AGAIN TO

1723
00:57:10,355 --> 00:57:12,457
HAVE THESE IMPORTANT EFFECTS ON

1724
00:57:12,457 --> 00:57:18,663
DIABETES AND BLEATS  OBESITY, AN

1725
00:57:18,663 --> 00:57:20,198
IMPORTANT FIELD, WE CAN LOOK

1726
00:57:20,198 --> 00:57:27,005
BACK IN 10 TO 15 YEARS MOVING IN

1727
00:57:27,005 --> 00:57:28,406
THIS DIRECTION, AND WE'RE MAKING

1728
00:57:28,406 --> 00:57:31,142
A DIFFERENCE.

1729
00:57:31,142 --> 00:57:33,978
I'LL SUMMARIZE AND HAPPY TO TAKE

1730
00:57:33,978 --> 00:57:34,412
QUESTIONS.

1731
00:57:34,412 --> 00:57:35,747
FIRST BULLET, DISPARITIES IN

1732
00:57:35,747 --> 00:57:39,217
DIABETES CHANGED OVER THE LAST

1733
00:57:39,217 --> 00:57:40,318
CENTURY, 130 YEARS AGO PEOPLE

1734
00:57:40,318 --> 00:57:43,321
SAID THEY DIDN'T SEE BLACK

1735
00:57:43,321 --> 00:57:45,290
PEOPLE WITH DIABETES, MAINLY A

1736
00:57:45,290 --> 00:57:45,657
JEWISH DISEASE.

1737
00:57:45,657 --> 00:57:46,925
HARD TO KNOW WITH DATA BUT

1738
00:57:46,925 --> 00:57:49,661
THINGS ARE VERY DIFFERENT NOW.

1739
00:57:49,661 --> 00:57:50,962
DISPARITIES LIKE I SAID WEREN'T

1740
00:57:50,962 --> 00:57:52,597
ALWAYS THAT WAY, WE CAN CHANGE

1741
00:57:52,597 --> 00:58:00,472
THEY ARE NOT ALWAYS THIS WAY FOR

1742
00:58:00,472 --> 00:58:01,506
FUTURE GENERATIONS.

1743
00:58:01,506 --> 00:58:02,907
SOCIAL DETERMINANTS PLAY A

1744
00:58:02,907 --> 00:58:06,311
GREATER ROLE THAN GENETICS.

1745
00:58:06,311 --> 00:58:07,278
THE PREVENTION PROGRAM WAS

1746
00:58:07,278 --> 00:58:09,714
EFFECTIVE BUT LOST IN

1747
00:58:09,714 --> 00:58:11,049
TRANSLATION THOSE BENEFITS,

1748
00:58:11,049 --> 00:58:12,884
PARTICULARLY FOR MINORITY GROUPS

1749
00:58:12,884 --> 00:58:14,752
THAT PROMISED IN 2002 NOT

1750
00:58:14,752 --> 00:58:16,588
REALIZED UP TO NOW.

1751
00:58:16,588 --> 00:58:18,356
AND TALKING ABOUT SCREENING,

1752
00:58:18,356 --> 00:58:19,891
DISPARITIES OUT THERE

1753
00:58:19,891 --> 00:58:20,992
PARTICULARLY ASIAN PATIENTS,

1754
00:58:20,992 --> 00:58:23,928
THEN AS WELL AS BLACK AND WHITE

1755
00:58:23,928 --> 00:58:25,129
PATIENTS AFTER GDM, WE NEED MORE

1756
00:58:25,129 --> 00:58:26,898
WORK TO UNDERSTAND IN MY MIND

1757
00:58:26,898 --> 00:58:28,666
WHY EVERYBODY NEEDS TO BE

1758
00:58:28,666 --> 00:58:32,270
SCREENED POSTPARTUM BUT WHY WE

1759
00:58:32,270 --> 00:58:33,271
AREN'T SCREENING ASIAN PATIENTS

1760
00:58:33,271 --> 00:58:34,572
GIVEN THEY HAVE DIABETES AT

1761
00:58:34,572 --> 00:58:36,341
HIGHER RATES THAN WHITE

1762
00:58:36,341 --> 00:58:36,608
PATIENTS.

1763
00:58:36,608 --> 00:58:39,177
AND THEN WHAT TO DO, WE TALKED

1764
00:58:39,177 --> 00:58:41,045
ABOUT RACE-SPECIFIC THRESHOLD

1765
00:58:41,045 --> 00:58:41,779
FOR SCREENING, BEING CONSIDERED,

1766
00:58:41,779 --> 00:58:43,548
TRYING TO FIGURE OUT HOW TO KEEP

1767
00:58:43,548 --> 00:58:45,517
PEOPLE IN THE DPP, AND THEN

1768
00:58:45,517 --> 00:58:46,518
PUBLIC POLICIES, MANY I COULD

1769
00:58:46,518 --> 00:58:49,487
HAVE TALKED ABOUT BUT THINGS

1770
00:58:49,487 --> 00:58:51,022
THAT CAN IMPROVE DIETARY

1771
00:58:51,022 --> 00:58:51,890
QUALITY, NEIGHBORHOOD LEVEL

1772
00:58:51,890 --> 00:58:54,058
DETERMINANTS WHERE OUR PATIENTS

1773
00:58:54,058 --> 00:58:56,027
LIVE AND WORK AND PLAY TO MAKE

1774
00:58:56,027 --> 00:58:58,229
DIFFERENCES WE CAN HAVE A

1775
00:58:58,229 --> 00:58:58,897
DIFFERENT DISPARITIES PICTURE IN

1776
00:58:58,897 --> 00:59:01,933
25 YEARS THAN WE DO TODAY.

1777
00:59:01,933 --> 00:59:06,638
SO WITH THAT, I WILL STOP AND

1778
00:59:06,638 --> 00:59:07,705
HAPPY TO TAKE QUESTIONS THAT

1779
00:59:07,705 --> 00:59:14,646
HAVE BEEN PUT IN THE CHAT.

1780
00:59:14,646 --> 00:59:16,481
>> THANK YOU FOR THE
TERRIFIC

1781
00:59:16,481 --> 00:59:16,881
OVERVIEW.

1782
00:59:16,881 --> 00:59:19,651
I LOVE THE HISTORY.

1783
00:59:19,651 --> 00:59:21,619
FOR THE DIVERSE AUDIENCE, A GOOD

1784
00:59:21,619 --> 00:59:23,488
EXPLANATION OF CLINICAL SPECTRUM

1785
00:59:23,488 --> 00:59:27,091
OF WHAT DIABETES IS ABOUT,

1786
00:59:27,091 --> 00:59:28,626
DIFFERENT POINTS.

1787
00:59:28,626 --> 00:59:30,962
I WONDER IF YOU COULD GIVE US

1788
00:59:30,962 --> 00:59:33,231
JUST A COUPLE MINUTES OF SENSE

1789
00:59:33,231 --> 00:59:36,434
OF WHAT YOU'RE WORKING ON WITH

1790
00:59:36,434 --> 00:59:39,771
RELATIONSHIP TO THIS IN YOUR OWN

1791
00:59:39,771 --> 00:59:41,472
RESEARCH, EITHER IN THE

1792
00:59:41,472 --> 00:59:44,542
COMMUNITY ENGAGEMENT PART OR

1793
00:59:44,542 --> 00:59:45,476
STRUCTURAL PART, SO --

1794
00:59:45,476 --> 00:59:46,411
>> YEAH, SURE.

1795
00:59:46,411 --> 00:59:50,381
AS YOU SIGH, I -- SEE, I

1796
00:59:50,381 --> 00:59:52,317
MENTIONED IN PASSING THE WORK WE

1797
00:59:52,317 --> 00:59:52,850
DO.

1798
00:59:52,850 --> 00:59:53,952
ESSENTIALLY A LOT OF SHARED

1799
00:59:53,952 --> 00:59:55,486
DECISION MAKING WORK IN DIABETES

1800
00:59:55,486 --> 00:59:55,820
PREVENTION.

1801
00:59:55,820 --> 00:59:57,455
SO WE WORK CLOSELY WITH

1802
00:59:57,455 --> 00:59:58,056
PHARMACISTS.

1803
00:59:58,056 --> 01:00:01,426
SO IT'S IN THE HEALTH SYSTEM.

1804
01:00:01,426 --> 01:00:02,694
I'M TRYING TO CONNECT WITH FOLKS

1805
01:00:02,694 --> 01:00:03,895
WHO DO MORE.

1806
01:00:03,895 --> 01:00:05,330
REALLY WORKING WITH PATIENTS TO

1807
01:00:05,330 --> 01:00:06,598
MAKE A DECISION WHAT DIABETES

1808
01:00:06,598 --> 01:00:08,800
PREVENTION OPTION IS THE BEST

1809
01:00:08,800 --> 01:00:09,534
FOR THEM.

1810
01:00:09,534 --> 01:00:11,936
WHETHER IT BE LIFESTYLE CHANGE

1811
01:00:11,936 --> 01:00:14,672
OR METFORMIN, PUTTING THAT INTO

1812
01:00:14,672 --> 01:00:15,039
PRACTICE.

1813
01:00:15,039 --> 01:00:17,508
IN OUR STUDIES, I ALSO WORK WITH

1814
01:00:17,508 --> 01:00:19,344
A COLLEAGUE, WE OVERSEE DPPs

1815
01:00:19,344 --> 01:00:20,445
AT ALL TEN UNIVERSITY OF

1816
01:00:20,445 --> 01:00:21,779
CALIFORNIA SITES.

1817
01:00:21,779 --> 01:00:27,018
THERE'S A BIG EFFORT IN U.C. FOR

1818
01:00:27,018 --> 01:00:28,353
BOTH PATIENTS, EMPLOYEES,

1819
01:00:28,353 --> 01:00:31,289
FACULTY, STAFF, TO SEE IF WE CAN

1820
01:00:31,289 --> 01:00:32,724
GET UNIVERSITY COMMUNITIES, IN

1821
01:00:32,724 --> 01:00:35,460
CALIFORNIA AS YOU KNOW THEY ARE

1822
01:00:35,460 --> 01:00:38,563
VERY DIVERSE, UCLA WE DO A LOT

1823
01:00:38,563 --> 01:00:40,231
OF WORK WITH DIETARY CAFETERIA

1824
01:00:40,231 --> 01:00:41,599
WORKERS, THEY HAVE HAD TIME OFF

1825
01:00:41,599 --> 01:00:43,434
TO PARTICIPATE IN THIS.

1826
01:00:43,434 --> 01:00:45,203
WE'RE TRACKING TO SEE ARE THEY

1827
01:00:45,203 --> 01:00:47,071
LOSING WEIGHT AT THE SAME RATE

1828
01:00:47,071 --> 01:00:48,139
WE'D LIKE TO SEE.

1829
01:00:48,139 --> 01:00:50,875
IF WE SEE THAT, THAT'S MORE

1830
01:00:50,875 --> 01:00:51,442
EVIDENCE THAT OTHER

1831
01:00:51,442 --> 01:00:52,977
INSTITUTIONS, FOR EXAMPLE, GIVE

1832
01:00:52,977 --> 01:00:54,612
THEIR DIVERSE WORK FORCES TIME

1833
01:00:54,612 --> 01:00:57,548
OFF TO PARTICIPATE SO THEY CAN

1834
01:00:57,548 --> 01:01:01,586
THEN -- WE CAN GET MORE

1835
01:01:01,586 --> 01:01:02,053
EQUITABLE TRANSLATION.

1836
01:01:02,053 --> 01:01:03,554
ALSO WORK WITH HEALTH PLAN, TO

1837
01:01:03,554 --> 01:01:07,959
TRY TO -- THEY DO WORK ON

1838
01:01:07,959 --> 01:01:08,926
HIGH-COST PATIENTS, WE'RE

1839
01:01:08,926 --> 01:01:14,632
FOCUSING ON GROUP WITH DIABETES

1840
01:01:14,632 --> 01:01:15,600
TO EVALUATE CASE MANAGEMENT

1841
01:01:15,600 --> 01:01:17,468
PROGRAMS TO CONNECT PEOPLE TO

1842
01:01:17,468 --> 01:01:18,670
SERVICES, CAN WE IMPROVE

1843
01:01:18,670 --> 01:01:20,638
DIABETES OUTCOMES AND CAN WE DO

1844
01:01:20,638 --> 01:01:23,007
THAT ALSO FOR PEOPLE OF

1845
01:01:23,007 --> 01:01:24,008
DIFFERENT RACIAL/ETHNIC GROUPS.

1846
01:01:24,008 --> 01:01:25,977
A FEW THINGS.

1847
01:01:25,977 --> 01:01:27,512
YOU GOT TO WRITE GRANTS,

1848
01:01:27,512 --> 01:01:28,212
DIFFERENT SPACES, DIFFERENT

1849
01:01:28,212 --> 01:01:29,047
COLLEAGUES, SO EXCITING BUT

1850
01:01:29,047 --> 01:01:30,248
THOSE ARE SOME THINGS I'M

1851
01:01:30,248 --> 01:01:32,316
WORKING ON RIGHT NOW AS WE

1852
01:01:32,316 --> 01:01:33,885
SPEAK.

1853
01:01:33,885 --> 01:01:34,886
>> THANK YOU.

1854
01:01:34,886 --> 01:01:36,521
AND MAYBE IF SOMEONE COULD STOP

1855
01:01:36,521 --> 01:01:37,955
SCREEN SHARING AND WE COULD SEE

1856
01:01:37,955 --> 01:01:41,859
EACH OTHER BETTER.

1857
01:01:41,859 --> 01:01:43,294
SO, A COUPLE COMMENTS.

1858
01:01:43,294 --> 01:01:46,664
ONE, YOU MAKE A STRONG CASE OF

1859
01:01:46,664 --> 01:01:50,301
YOUR OWN PERSPECTIVE THAT THE

1860
01:01:50,301 --> 01:01:55,306
DIABETES EPIDEMIC IS  PARALLEL

1861
01:01:55,306 --> 01:01:57,075
TO THE BREATHES EPIDEMIC,

1862
01:01:57,075 --> 01:01:57,742
INCREASE IN BMI.

1863
01:01:57,742 --> 01:01:59,711
YOU SHOWED THE NUMBERS.

1864
01:01:59,711 --> 01:02:01,946
BMI HAS BEEN GOING UP.

1865
01:02:01,946 --> 01:02:03,848
WHEN YOU LOOK AT THE RATE OF

1866
01:02:03,848 --> 01:02:05,950
DEVELOPMENT OF EACH OF THESE

1867
01:02:05,950 --> 01:02:08,786
CONDITIONS, THEY ARE NOT QUITE

1868
01:02:08,786 --> 01:02:09,320
THE SAME.

1869
01:02:09,320 --> 01:02:11,189
SO THERE ARE CLEARLY OTHER

1870
01:02:11,189 --> 01:02:12,190
FACTORS THAT GO INTO THIS.

1871
01:02:12,190 --> 01:02:14,692
THERE ARE SOME PEOPLE WHO ARE

1872
01:02:14,692 --> 01:02:17,161
HIGH BMI AND DON'T GET DIABETES.

1873
01:02:17,161 --> 01:02:21,132
WE FOCUS ON ASIAN AMERICANS WHO

1874
01:02:21,132 --> 01:02:22,667
ESPECIALLY SOUTH ASIANS WHO ARE

1875
01:02:22,667 --> 01:02:25,837
NOT ABOVE A CERTAIN LEVEL AND

1876
01:02:25,837 --> 01:02:28,740
YET DEVELOP DIABETES.

1877
01:02:28,740 --> 01:02:30,408
SO WHAT DO YOU THINK ELSE IS

1878
01:02:30,408 --> 01:02:33,945
GOING ON HERE IN TERMS OF THIS?

1879
01:02:33,945 --> 01:02:35,279
>> YEAH, THAT'S A GREAT

1880
01:02:35,279 --> 01:02:35,546
QUESTION.

1881
01:02:35,546 --> 01:02:37,448
I'LL SAY THIS.

1882
01:02:37,448 --> 01:02:41,052
AS YOU KNOW, ELISEO, BMI IS

1883
01:02:41,052 --> 01:02:42,720
DEFINITELY NOT A PERFECT METRIC.

1884
01:02:42,720 --> 01:02:44,122
IT'S WHAT WE MEASURE.

1885
01:02:44,122 --> 01:02:45,323
WE'RE LEARNING MORE ABOUT BODY

1886
01:02:45,323 --> 01:02:47,191
COMPOSITION, THAT IS THE DRIVING

1887
01:02:47,191 --> 01:02:47,625
FACTOR.

1888
01:02:47,625 --> 01:02:50,495
I WISH WE HAD CTs AND MRIs,

1889
01:02:50,495 --> 01:02:53,965
COULD GO BACK IN TIME AND GET

1890
01:02:53,965 --> 01:02:56,367
BODY COMPOSITION STUDIES IN

1891
01:02:56,367 --> 01:02:57,034
1898, 1920, 1950.

1892
01:02:57,034 --> 01:02:59,003
I KNOW WHERE YOU'RE GOING.

1893
01:02:59,003 --> 01:03:00,772
SO MUCH IS VISCERAL FAT.

1894
01:03:00,772 --> 01:03:02,073
WE BELIEVE THAT CHANGES IN

1895
01:03:02,073 --> 01:03:04,008
VISCERAL FAT IS WHAT IS HONESTLY

1896
01:03:04,008 --> 01:03:05,777
DRIVING THIS, WHEN YOU DIG INTO

1897
01:03:05,777 --> 01:03:10,047
THE  OBESITY.

1898
01:03:10,047 --> 01:03:15,419
GREATER VISCERAL FAT AND NOT AS

1899
01:03:15,419 --> 01:03:17,822
HIGH BMI, IT'S NOT 1:1

1900
01:03:17,822 --> 01:03:18,689
CORRELATED BUT VISCERAL FAT,

1901
01:03:18,689 --> 01:03:21,225
ANYONE WHO CAN FIGURE OUT HOW

1902
01:03:21,225 --> 01:03:23,060
THAT WORKS EXACTLY IS GETTING A

1903
01:03:23,060 --> 01:03:24,262
NOBEL PRIZE.

1904
01:03:24,262 --> 01:03:26,597
IT'S CLEAR, WHEN YOU DO GASTRIC

1905
01:03:26,597 --> 01:03:28,332
BYPASS SURGERY PEOPLE LOSE

1906
01:03:28,332 --> 01:03:30,201
VISCERAL FAT, DIABETES IS

1907
01:03:30,201 --> 01:03:30,968
QUOTE/UNQUOTE REVERSED.

1908
01:03:30,968 --> 01:03:33,171
EVEN IF THEY HAVE FAT STILL IN

1909
01:03:33,171 --> 01:03:34,472
THEIR ARMS AND LEGS, THE

1910
01:03:34,472 --> 01:03:35,907
VISCERAL GUT FAT IS WHAT IS

1911
01:03:35,907 --> 01:03:37,208
DRIVING SO MUCH OF THIS.

1912
01:03:37,208 --> 01:03:39,844
SO I THINK TO YOUR POINT, THAT'S

1913
01:03:39,844 --> 01:03:42,580
ACTUALLY A BETTER PREDICTOR THAN

1914
01:03:42,580 --> 01:03:44,415
BMI, SOME STUDIES SHOW CHANGE IN

1915
01:03:44,415 --> 01:03:46,617
THAT OVER THE LAST 150 YEARS, IF

1916
01:03:46,617 --> 01:03:48,586
WE COULD MEASURE IT, IS MORE

1917
01:03:48,586 --> 01:03:49,921
CLOSELY LINKED TO WHAT WE'VE

1918
01:03:49,921 --> 01:03:52,857
BEEN TALKING ABOUT TODAY.

1919
01:03:52,857 --> 01:03:53,391
>> THANK YOU.

1920
01:03:53,391 --> 01:03:57,562
NO, IT WOULD BE A GOOD THING

1921
01:03:57,562 --> 01:03:58,830
BECAUSE THERE'S ALSO, AS I'M

1922
01:03:58,830 --> 01:04:02,733
SURE YOU KNOW, AS A PHYSICIAN, A

1923
01:04:02,733 --> 01:04:04,368
LOT OF INDIVIDUALS IN THE

1924
01:04:04,368 --> 01:04:06,637
COMMUNITY WHO SORT OF RESENT THE

1925
01:04:06,637 --> 01:04:09,507
LABEL OF OBESITY, CALLING IT A

1926
01:04:09,507 --> 01:04:12,210
DISEASE, AND CLINICIANS DO TEND

1927
01:04:12,210 --> 01:04:16,047
TO -- WE DO TEND TO WANT TO

1928
01:04:16,047 --> 01:04:18,115
CATEGORIZE, YOUR BMI IS ABOVE A

1929
01:04:18,115 --> 01:04:20,751
CERTAIN POINT, AND PEOPLE --

1930
01:04:20,751 --> 01:04:23,354
THERE'S DIFFERENT CULTURAL SORT

1931
01:04:23,354 --> 01:04:25,790
OF PERCEPTIONS OF THAT, SO IT'S

1932
01:04:25,790 --> 01:04:35,867
NOT SUCH A SORT OF STRAIGHTFORD 

1933
01:04:35,867 --> 01:04:42,006
-- STRAIGHTFORWARD ALL THE TIME.

1934
01:04:42,006 --> 01:04:44,075
METFORMIN WORKS, RELATIVELY FEW

1935
01:04:44,075 --> 01:04:45,610
SIDE EFFECTS, IT'S EASY, SEVERE

1936
01:04:45,610 --> 01:04:46,978
SIDE EFFECTS ARE RARE BUT WE

1937
01:04:46,978 --> 01:04:54,418
ALWAYS WORRY ABOUT THEM. 

1938
01:04:54,418 --> 01:04:55,186
I THINK NON-ELDERLY PARTICIPANTS

1939
01:04:55,186 --> 01:04:57,555
WORKED AS WELL AS LIFESTYLE.

1940
01:04:57,555 --> 01:05:00,191
WHAT ARE YOUR THOUGHTS ON THAT?

1941
01:05:00,191 --> 01:05:01,959
>> YES, I PROMISE I DIDN'T
GIVE

1942
01:05:01,959 --> 01:05:03,027
YOU THESE QUESTIONS AHEAD OF

1943
01:05:03,027 --> 01:05:03,361
TIME.

1944
01:05:03,361 --> 01:05:04,562
I DIDN'T FEED YOU THIS.

1945
01:05:04,562 --> 01:05:06,297
YES, TWO THINGS.

1946
01:05:06,297 --> 01:05:08,299
ONE IS ACTUALLY I DIDN'T TALK

1947
01:05:08,299 --> 01:05:10,268
ABOUT THIS, YOU CAN ONLY TALK

1948
01:05:10,268 --> 01:05:15,072
ABOUT SO MUCH, IN WOMEN IN DPP

1949
01:05:15,072 --> 01:05:16,974
WITH GESTATIONAL DIABETES

1950
01:05:16,974 --> 01:05:18,142
METFORMIN WORKED AS WELL.

1951
01:05:18,142 --> 01:05:20,211
GOING BACK TO MY WORK WE'RE

1952
01:05:20,211 --> 01:05:21,545
DOING SHARED DECISION MAKING,

1953
01:05:21,545 --> 01:05:23,414
REALLY GETTING AT THAT AS IS

1954
01:05:23,414 --> 01:05:25,449
LIFESTYLE CHANGE RIGHT FOR YOU?

1955
01:05:25,449 --> 01:05:26,550
OR IS METFORMIN RIGHT FOR YOU?

1956
01:05:26,550 --> 01:05:28,319
OR CAN YOU DO BOTH?

1957
01:05:28,319 --> 01:05:30,421
JUST BECAUSE BOTH WEREN'T

1958
01:05:30,421 --> 01:05:32,256
OFFERED DOESN'T MEAN YOU CAN'T

1959
01:05:32,256 --> 01:05:33,024
DO IT.

1960
01:05:33,024 --> 01:05:36,460
OUR TEAM REALLY HAS PUSHED THIS

1961
01:05:36,460 --> 01:05:39,730
ISSUE HARD, AROUND ANNALS PAPER,

1962
01:05:39,730 --> 01:05:41,132
FIVE YEARS AGO, SHOWING

1963
01:05:41,132 --> 01:05:42,266
NATIONWIDE USE OF METFORMIN IS

1964
01:05:42,266 --> 01:05:43,801
VERY LOW IN THESE PATIENTS,

1965
01:05:43,801 --> 01:05:46,070
WE'VE BEEN TRYING TO PUSH IT BUT

1966
01:05:46,070 --> 01:05:48,072
PUSHBACK BECAUSE IT'S NOT FDA

1967
01:05:48,072 --> 01:05:49,674
APPROVED, PEOPLE DON'T LIKE

1968
01:05:49,674 --> 01:05:53,511
THAT. 

1969
01:05:53,511 --> 01:05:55,479
B, SOMEONE IN CDC TOLD ME THESE

1970
01:05:55,479 --> 01:05:57,148
PEOPLE WILL EAT THEIR WAY OUT OF

1971
01:05:57,148 --> 01:05:58,115
A PILL SO THEREFORE WE THINK

1972
01:05:58,115 --> 01:06:00,751
THIS IS NOT GOING TO BE THE

1973
01:06:00,751 --> 01:06:02,586
ANSWER.

1974
01:06:02,586 --> 01:06:02,887
>> RIGHT.

1975
01:06:02,887 --> 01:06:03,587
I WOULD COUNTER THAT.

1976
01:06:03,587 --> 01:06:04,689
>> I AGREE.

1977
01:06:04,689 --> 01:06:06,090
>> A COUPLE OTHER
QUESTIONS THAT

1978
01:06:06,090 --> 01:06:07,458
WE'RE GETTING IN.

1979
01:06:07,458 --> 01:06:11,028
HERE'S FIRST ONE, DO YOU THINK

1980
01:06:11,028 --> 01:06:13,197
THE ISSUE WITH ASIANS HAS TO DO

1981
01:06:13,197 --> 01:06:14,732
WITH APPEARANCE, THEY MIGHT

1982
01:06:14,732 --> 01:06:18,235
CARRY MOST OF THE WEIGHT IN

1983
01:06:18,235 --> 01:06:21,739
ABDOMEN, WE TOUCHED THAT,

1984
01:06:21,739 --> 01:06:22,707
TRUNCAL OBESITY.

1985
01:06:22,707 --> 01:06:25,042
>> NO OTHER THOUGHTS, I
GUESS

1986
01:06:25,042 --> 01:06:26,243
I'M JUST STILL -- I DON'T THINK

1987
01:06:26,243 --> 01:06:28,980
WE KNOW WHY PEOPLE AREN'T

1988
01:06:28,980 --> 01:06:29,447
GETTING SCREENED.

1989
01:06:29,447 --> 01:06:30,848
MAYBE PARTIALLY DUE TO

1990
01:06:30,848 --> 01:06:32,817
DIFFERENCES IN APPEARANCE.

1991
01:06:32,817 --> 01:06:35,119
EVEN IF BMI ABOVE 30, RATES ARE

1992
01:06:35,119 --> 01:06:36,320
STILL LOWER.

1993
01:06:36,320 --> 01:06:38,055
PART HAS TO DO WITH HONESTLY

1994
01:06:38,055 --> 01:06:40,891
BIAS ON THE PART OF CLINICIANS

1995
01:06:40,891 --> 01:06:43,094
AND OTHERS, MAY NOT BE THINKING

1996
01:06:43,094 --> 01:06:46,364
THIS, MAY NOT BE DOING SCREENING

1997
01:06:46,364 --> 01:06:48,132
TESTS WE SHOULD, KNOWING

1998
01:06:48,132 --> 01:06:50,735
PREVALENCE RATE FOR THESE

1999
01:06:50,735 --> 01:06:51,002
PATIENTS.

2000
01:06:51,002 --> 01:06:55,706
>> OVER THE YEARS, I
HAVEN'T

2001
01:06:55,706 --> 01:06:57,575
PRACTICED IN ALMOST NINE YEARS,

2002
01:06:57,575 --> 01:06:59,076
BUT WHY NOT SCREEN EVERYBODY

2003
01:06:59,076 --> 01:07:00,711
ABOVE A CERTAIN AGE?

2004
01:07:00,711 --> 01:07:02,079
YOU'RE GETTING DOWN TO -- NOW

2005
01:07:02,079 --> 01:07:05,850
IT'S LIKE 70% OF THE POPULATION,

2006
01:07:05,850 --> 01:07:09,687
OVERWEIGHT OR OBESE, BMI ABOVE

2007
01:07:09,687 --> 01:07:10,121
25.

2008
01:07:10,121 --> 01:07:11,989
LOWER FOR SOME GROUPS.

2009
01:07:11,989 --> 01:07:15,693
SO, I THINK IN THE CONTEXT OF

2010
01:07:15,693 --> 01:07:19,630
WHAT PEOPLE GET, UNNECESSARY

2011
01:07:19,630 --> 01:07:22,266
TESTS ANYWAY, ADDING A1c TO

2012
01:07:22,266 --> 01:07:24,769
YOUR BLOOD DRAW SEEMS BENIGN TO

2013
01:07:24,769 --> 01:07:26,504
ME AND DOES PROVIDE SOME USEFUL

2014
01:07:26,504 --> 01:07:28,272
INFORMATION TO THE PATIENT'S

2015
01:07:28,272 --> 01:07:28,906
FUTURE.

2016
01:07:28,906 --> 01:07:29,907
NOW, HERE'S ANOTHER QUESTION,

2017
01:07:29,907 --> 01:07:32,643
GIVEN WHAT YOU KNOW, YOUR

2018
01:07:32,643 --> 01:07:33,577
RESEARCH AND EXTENSIVE EXPERTISE

2019
01:07:33,577 --> 01:07:37,114
IN THE CARE OF PATIENTS WITH

2020
01:07:37,114 --> 01:07:40,317
DIABETES, WHAT WOULD BE ON YOUR

2021
01:07:40,317 --> 01:07:42,486
CLINICIAN'S WISH LIST OF

2022
01:07:42,486 --> 01:07:43,921
COMPONENTS OF AN ELECTRONIC

2023
01:07:43,921 --> 01:07:45,890
MEDICAL RECORD SYSTEM THAT MAY

2024
01:07:45,890 --> 01:07:48,726
MITIGATE THE SOCIAL REASONS THAT

2025
01:07:48,726 --> 01:07:50,194
ARE BARRIERS TO ENHANCED

2026
01:07:50,194 --> 01:07:51,462
SUSTAINABILITY OF PARTICIPATION

2027
01:07:51,462 --> 01:07:56,100
IN THE DPP AND BALANCES,

2028
01:07:56,100 --> 01:07:58,903
EFFICIENTLY WITH PHYSICIAN, LONG

2029
01:07:58,903 --> 01:08:00,371
QUESTION, EVIDENCE-BASED

2030
01:08:00,371 --> 01:08:01,305
CLINICAL DECISION SUPPORT,

2031
01:08:01,305 --> 01:08:04,241
INCORPORATION PATIENT SHARED

2032
01:08:04,241 --> 01:08:06,544
DECISION TO FACILITATE DIABETES

2033
01:08:06,544 --> 01:08:08,846
POPULATION HEALTH SCREENING,

2034
01:08:08,846 --> 01:08:11,715
LIFESTYLE AND TREATMENT 

2035
01:08:11,715 --> 01:08:14,919
COMPLIANCE TO PREVENT SECONDARY

2036
01:08:14,919 --> 01:08:16,854
DIABETIC COMPLICATIONS IN RACIAL

2037
01:08:16,854 --> 01:08:17,588
AND ETHNIC MINORITIES.

2038
01:08:17,588 --> 01:08:18,389
>> THAT WAS LONG.

2039
01:08:18,389 --> 01:08:20,024
I'LL TRY MY BEST TO ANSWER THIS.

2040
01:08:20,024 --> 01:08:24,428
WE TOUCHED ON THIS IN THE MEET

2041
01:08:24,428 --> 01:08:25,729
AND GREET EARLIER.

2042
01:08:25,729 --> 01:08:27,531
EHR AS WE KNOW IT IS BUILT FOR

2043
01:08:27,531 --> 01:08:29,400
BILLING, THAT'S WHAT IT IS.

2044
01:08:29,400 --> 01:08:30,901
YOU CAN'T GET OUT OF THERE

2045
01:08:30,901 --> 01:08:32,970
UNLESS YOU DO A BILLING, YOU

2046
01:08:32,970 --> 01:08:34,405
FILE A CHARGE.

2047
01:08:34,405 --> 01:08:35,706
IT'S NOT ORIENTED TOWARDS

2048
01:08:35,706 --> 01:08:36,340
ADDRESSING SOCIAL DETERMINANTS

2049
01:08:36,340 --> 01:08:36,707
OF HEALTH.

2050
01:08:36,707 --> 01:08:38,676
PART OF THE PROBLEM IS WE PUT

2051
01:08:38,676 --> 01:08:40,511
MODULES IN BUT NOBODY FILLS THEM

2052
01:08:40,511 --> 01:08:40,744
OUT.

2053
01:08:40,744 --> 01:08:43,047
WHEN YOU GO LOOK AT IT, IT'S

2054
01:08:43,047 --> 01:08:44,248
EMPTY.

2055
01:08:44,248 --> 01:08:46,517
IT'S NOT VERY HELPFUL.

2056
01:08:46,517 --> 01:08:48,486
I'D LOVE TO SEE SOMETHING THAT

2057
01:08:48,486 --> 01:08:51,021
JUST POPS UP ON THE SCREEN THAT

2058
01:08:51,021 --> 01:08:54,391
TELLS MORE ABOUT THE PATIENT.

2059
01:08:54,391 --> 01:08:55,159
EVEN SOCIAL DETERMINANTS BUT

2060
01:08:55,159 --> 01:08:57,061
ALSO WHO THEY ARE AS A PERSON.

2061
01:08:57,061 --> 01:09:01,098
WHAT TV SHOWS THEY LIKE, THESE

2062
01:09:01,098 --> 01:09:03,167
KIND OF THINGS, YOU GET TO KNOW

2063
01:09:03,167 --> 01:09:05,035
AND BUILD TRUST, GET TO KNOW WHO

2064
01:09:05,035 --> 01:09:05,903
THEY ARE.

2065
01:09:05,903 --> 01:09:07,071
PATIENTS DON'T HAVE CONTINUITY.

2066
01:09:07,071 --> 01:09:08,305
DOCTOR DOESN'T KNOW THEM.

2067
01:09:08,305 --> 01:09:09,373
THEY DON'T TRUST THEM, THEY ARE

2068
01:09:09,373 --> 01:09:11,041
NOT WILLING TO DO THE DPP THEN

2069
01:09:11,041 --> 01:09:12,476
OR DO THINGS THAT ARE HEALTHY

2070
01:09:12,476 --> 01:09:13,043
FOR THEM.

2071
01:09:13,043 --> 01:09:15,546
I'D LOVE TO SEE THAT IN THE EHR,

2072
01:09:15,546 --> 01:09:18,616
A SEPARATE BOX, THIS IS THE

2073
01:09:18,616 --> 01:09:19,183
PATIENT'S PERSONALITY BOX.

2074
01:09:19,183 --> 01:09:21,051
I THINK THAT WOULD BE USEFUL IN

2075
01:09:21,051 --> 01:09:22,786
BUILDING A TRUST AND I'M

2076
01:09:22,786 --> 01:09:25,756
ACTUALLY WORKING WITH A SCHOLAR,

2077
01:09:25,756 --> 01:09:27,725
ELISEO, WHO HAS THAT SAME IDEA.

2078
01:09:27,725 --> 01:09:29,460
I CAN'T CLAIM TOTAL OWNERSHIP OF

2079
01:09:29,460 --> 01:09:29,693
THAT.

2080
01:09:29,693 --> 01:09:30,761
BUT I DO THINK THAT'S THE KIND

2081
01:09:30,761 --> 01:09:32,329
OF THING THAT WOULD BE HELPFUL

2082
01:09:32,329 --> 01:09:34,632
TO ADD, ONE THING AT LEAST.

2083
01:09:34,632 --> 01:09:35,166
>> THAT'S GREAT.

2084
01:09:35,166 --> 01:09:37,668
AND ONE OF THE THINGS I WOULD

2085
01:09:37,668 --> 01:09:40,437
HAVE SAID WHEN I WAS SEEING

2086
01:09:40,437 --> 01:09:41,438
PATIENTS IS, YOU KNOW, WHAT YOU

2087
01:09:41,438 --> 01:09:42,473
JUST DESCRIBED, I DON'T KNOW

2088
01:09:42,473 --> 01:09:44,909
ABOUT TV SHOWS, BUT IN GENERAL

2089
01:09:44,909 --> 01:09:46,343
GET TO KNOW THE PATIENT, THE

2090
01:09:46,343 --> 01:09:49,180
MOST IMPORTANT PART OF WHAT WE

2091
01:09:49,180 --> 01:09:51,048
DO INITIALLY AS OPPOSED TO, YOU

2092
01:09:51,048 --> 01:09:52,483
KNOW, THE SYMPTOMS AND REVIEW OF

2093
01:09:52,483 --> 01:09:54,518
SYSTEMS AND ALL THE THE OTHER

2094
01:09:54,518 --> 01:09:56,854
STUFF WE'RE PROGRAMMED TO DO ALL

2095
01:09:56,854 --> 01:09:58,155
THE TIME.

2096
01:09:58,155 --> 01:10:01,625
ANOTHER QUESTION, WHAT ARE SOME

2097
01:10:01,625 --> 01:10:03,827
INNOVATIVE PRACTICES YOU HAVE

2098
01:10:03,827 --> 01:10:05,930
OBSERVED THAT HAVE HELPED

2099
01:10:05,930 --> 01:10:08,432
ATTENUATE DISPARITIES ACROSS THE

2100
01:10:08,432 --> 01:10:10,501
DIVERSE ASIAN SUBGROUPS WHICH

2101
01:10:10,501 --> 01:10:14,238
YOU DISCUSSED IN NHANES DATA,

2102
01:10:14,238 --> 01:10:16,740
CONSIDERING PATIENTS VALUES,

2103
01:10:16,740 --> 01:10:20,211
CULTURE, INTERSECTIONAL AND

2104
01:10:20,211 --> 01:10:25,416
SDOH, AND DR. HILL BRIGG'S WORK

2105
01:10:25,416 --> 01:10:26,850
YOU DISCUSSED ACROSS THE LIFE

2106
01:10:26,850 --> 01:10:27,251
COURSE.

2107
01:10:27,251 --> 01:10:28,519
>> IT'S GREAT TO WORK WITH

2108
01:10:28,519 --> 01:10:29,587
YOUNGER FOLKS WITH EXCITING

2109
01:10:29,587 --> 01:10:30,454
IDEAS, YOU SUPPORT THEM, BUT

2110
01:10:30,454 --> 01:10:34,358
THERE'S A NURSE AT UCLA WHO IS

2111
01:10:34,358 --> 01:10:35,559
INTERESTED IN FILIPINO AMERICANS

2112
01:10:35,559 --> 01:10:36,594
WITH DIABETES, HE'S DOING WORK

2113
01:10:36,594 --> 01:10:37,595
IN THIS GROUP.

2114
01:10:37,595 --> 01:10:40,531
I THINK HIS BELIEF IS, AND WE'RE

2115
01:10:40,531 --> 01:10:43,067
TESTING THIS, THERE'S SOMETHING

2116
01:10:43,067 --> 01:10:48,973
CALLED A COLONIAL MENTALITY THAT

2117
01:10:48,973 --> 01:10:50,174
MANY FILIPINO AMERICANS HAVE,

2118
01:10:50,174 --> 01:10:54,878
LOSS OF SELF-ESTEEM AND 

2119
01:10:54,878 --> 01:10:56,847
SELF-WORTH, FILIPINO TERMS

2120
01:10:56,847 --> 01:10:59,383
DESIGNATE THIS.

2121
01:10:59,383 --> 01:11:00,784
SKIN COLOR AND ACCULTURATION ARE

2122
01:11:00,784 --> 01:11:02,753
BIG DRIVERS OF BEHAVIOR WITHIN

2123
01:11:02,753 --> 01:11:04,622
MANY GROUPS, AND SO I THINK

2124
01:11:04,622 --> 01:11:06,624
TRYING TO WORK WITH FILIPINO

2125
01:11:06,624 --> 01:11:08,025
PATIENTS AND STAFF TO GET A

2126
01:11:08,025 --> 01:11:11,595
SENSE OF WHAT THEIR BELIEFS ARE

2127
01:11:11,595 --> 01:11:12,730
AND PERCEPTIONS ABOUT DIABETES

2128
01:11:12,730 --> 01:11:17,334
TIED TO OTHER FILIPINOS TO

2129
01:11:17,334 --> 01:11:19,169
BECOME AWARE OF THESE THINGS AND

2130
01:11:19,169 --> 01:11:21,238
MAKE THE CHANGES TO IMPROVE

2131
01:11:21,238 --> 01:11:21,538
THEIR CARE.

2132
01:11:21,538 --> 01:11:23,440
SO MUCH ALONG WITH SOCIAL IS

2133
01:11:23,440 --> 01:11:24,008
VERY CULTURAL.

2134
01:11:24,008 --> 01:11:25,909
I THINK I HAVE TO PLEAD

2135
01:11:25,909 --> 01:11:27,411
IGNORANCE, I DON'T HAVE CULTURAL

2136
01:11:27,411 --> 01:11:29,280
COMPETENCE TO DO THIS WORK

2137
01:11:29,280 --> 01:11:31,148
MYSELF BUT I'M GLAD TO BE

2138
01:11:31,148 --> 01:11:32,149
PARTNERING WITH THIS INDIVIDUAL

2139
01:11:32,149 --> 01:11:32,916
WHO DOES.

2140
01:11:32,916 --> 01:11:34,118
THOSE THE THINGS WE NEED TO SEE,

2141
01:11:34,118 --> 01:11:36,420
IF WE'RE GOING TO TACKLE THIS

2142
01:11:36,420 --> 01:11:38,055
IT'S SOCIAL AND DEFINITELY THE

2143
01:11:38,055 --> 01:11:39,490
CULTURAL AS WELL AS BUILT

2144
01:11:39,490 --> 01:11:40,791
ENVIRONMENT IN TERMS OF DRIVING

2145
01:11:40,791 --> 01:11:45,629
THESE DISPARITIES.

2146
01:11:45,629 --> 01:11:45,763
 

2147
01:11:45,763 --> 01:11:46,063
>> RIGHT.

2148
01:11:46,063 --> 01:11:46,730
THANK YOU.

2149
01:11:46,730 --> 01:11:48,499
I KNOW IN CALIFORNIA WE ALWAYS

2150
01:11:48,499 --> 01:11:51,101
SAW A LOT OF FILIPINO PATIENTS,

2151
01:11:51,101 --> 01:11:57,641
SO I THINK YOU SEE LESS IN THIS

2152
01:11:57,641 --> 01:11:58,976
AREA, OR OUTSIDE OF REALLY

2153
01:11:58,976 --> 01:12:00,511
CALIFORNIA, A COUPLE OTHER

2154
01:12:00,511 --> 01:12:01,312
REGIONS.

2155
01:12:01,312 --> 01:12:03,580
I WOULD ALSO, YOU KNOW, WE CALL

2156
01:12:03,580 --> 01:12:05,449
ASIANS A VERY HETEROGENEOUS

2157
01:12:05,449 --> 01:12:09,086
GROUP, IN REALITY SOUTH ASIANS

2158
01:12:09,086 --> 01:12:11,221
ARE REALLY DIFFERENT.

2159
01:12:11,221 --> 01:12:13,424
THEY DON'T SHARE MUCH OF THE

2160
01:12:13,424 --> 01:12:16,493
EAST ASIAN CULTURE OR HISTORY OR

2161
01:12:16,493 --> 01:12:18,362
BACKGROUND OR HERITAGE.

2162
01:12:18,362 --> 01:12:20,431
AND THERE HAVE BEEN NOW A NUMBER

2163
01:12:20,431 --> 01:12:22,433
OF STUDIES SHOWING THAT SOUTH

2164
01:12:22,433 --> 01:12:26,036
ASIAN POPULATION IS HIGHER RISK 

2165
01:12:26,036 --> 01:12:28,005
OF DIABETES AND CARDIOVASCULAR

2166
01:12:28,005 --> 01:12:30,741
DISEASE, YET DESPITE NOT HAVING

2167
01:12:30,741 --> 01:12:32,609
AS MUCH OBESITY IN BEING AT

2168
01:12:32,609 --> 01:12:36,113
LEAST A SIGNIFICANT NUMBER BEING

2169
01:12:36,113 --> 01:12:37,981
VEGETARIAN, SO YOU GET THIS SORT

2170
01:12:37,981 --> 01:12:39,950
OF REVERSE PARADOX, YOU DO WORSE

2171
01:12:39,950 --> 01:12:41,051
EVEN THOUGH YOU'RE NOT SUPPOSED

2172
01:12:41,051 --> 01:12:43,787
TO, AND THIS IS WHERE SOME OF

2173
01:12:43,787 --> 01:12:50,561
THE INTEREST IN BOTH METABOLIC 

2174
01:12:50,561 --> 01:12:52,029
DIFFERENCES OF FAT AND DIFFERENT

2175
01:12:52,029 --> 01:12:56,834
MEDIATORS THAT COULD LEAD TO

2176
01:12:56,834 --> 01:12:57,434
THIS DIFFERENCE, DIFFERENT

2177
01:12:57,434 --> 01:12:59,136
RECEPTORS, THERE'S BEEN A TON OF

2178
01:12:59,136 --> 01:13:03,707
WORK ON GENETICS, I'LL LOOK UP 

2179
01:13:03,707 --> 01:13:05,042
THE PAPER YOU MENTIONED.

2180
01:13:05,042 --> 01:13:07,344
FRANCIS COLLINS'S LAB WAS

2181
01:13:07,344 --> 01:13:12,383
WORKING ON GENETICS OF EFFECT TO

2182
01:13:12,383 --> 01:13:14,651
DIABETES, THE INSULIN RESISTANCE

2183
01:13:14,651 --> 01:13:15,652
SPECTRUM OF DIABETES.

2184
01:13:15,652 --> 01:13:19,256
WHICH IS GOOD.

2185
01:13:19,256 --> 01:13:20,124
ANOTHER QUESTION, DPP

2186
01:13:20,124 --> 01:13:21,024
INTERVENTION RESULTS LOOK GREAT

2187
01:13:21,024 --> 01:13:23,660
IN ALL THREE ARMS, OKAY?

2188
01:13:23,660 --> 01:13:25,629
WHAT HAPPENS ONCE RESEARCH

2189
01:13:25,629 --> 01:13:26,497
PROJECT ENDS IN MINORITY

2190
01:13:26,497 --> 01:13:27,931
POPULATION, DO WE NEED LONGER

2191
01:13:27,931 --> 01:13:29,366
FOLLOW-UPS?  YOU SHOWED THE DATA

2192
01:13:29,366 --> 01:13:32,536
OF THE FOLLOW-UP STUDY WHERE YOU

2193
01:13:32,536 --> 01:13:35,406
CONTINUE TO SEE INCREASED RATES

2194
01:13:35,406 --> 01:13:36,807
OF DIABETES, STILL SEPARATION

2195
01:13:36,807 --> 01:13:37,374
GAINED.

2196
01:13:37,374 --> 01:13:38,675
SO IT WAS ENCOURAGING THAT

2197
01:13:38,675 --> 01:13:40,511
WHATEVER WAS DONE IN THOSE THREE

2198
01:13:40,511 --> 01:13:45,549
TO FIVE YEARS OF BEING IN THE

2199
01:13:45,549 --> 01:13:48,852
STUDY IMPACTED PEOPLE OVER 20

2200
01:13:48,852 --> 01:13:50,721
YEARS OF FOLLOW-UP?

2201
01:13:50,721 --> 01:13:53,357
>> 18 YEARS OR
THEREABOUTS.

2202
01:13:53,357 --> 01:13:54,858
>>  18, OKAY.

2203
01:13:54,858 --> 01:13:58,362
DO WE NEED LONGER FOLLOW-UPS?

2204
01:13:58,362 --> 01:14:04,401
A LOT OF GUIDELINES  FROM TASK

2205
01:14:04,401 --> 01:14:05,803
FORCE, SCREENING RATES HAVE NOT

2206
01:14:05,803 --> 01:14:06,570
IMPROVED, INCLUDING PREGNANCY.

2207
01:14:06,570 --> 01:14:08,772
CAN YOU SPEAK TO THE STUDY THAT

2208
01:14:08,772 --> 01:14:10,407
INDICATE THAT CHILDREN IN

2209
01:14:10,407 --> 01:14:15,679
FAMILIES IN A HAVE MANY FRESH

2210
01:14:15,679 --> 01:14:16,847
FRUITS CONSUMED MORE SUGAR, TWO

2211
01:14:16,847 --> 01:14:18,515
TO THREE ORANGES EQUALS ONE

2212
01:14:18,515 --> 01:14:20,818
GLASS OF JUICE, SHOULD

2213
01:14:20,818 --> 01:14:21,452
GUIDELINES CHANGE?

2214
01:14:21,452 --> 01:14:23,654
TWO-PART QUESTION.

2215
01:14:23,654 --> 01:14:25,088
FOLLOW-UP AND HOW DOES THAT

2216
01:14:25,088 --> 01:14:28,358
MAYBE -- HAVE WE SEEN ANY

2217
01:14:28,358 --> 01:14:30,794
IMPROVEMENT OR DECREASE IN GAPS?

2218
01:14:30,794 --> 01:14:34,331
>> IN TERMS OF THE
FOLLOW-UP,

2219
01:14:34,331 --> 01:14:36,467
I'LL SAY THAT PEOPLE TEND TO

2220
01:14:36,467 --> 01:14:38,001
REGAIN WEIGHT, SO THEY LOSE

2221
01:14:38,001 --> 01:14:39,436
WEIGHT, WE KNOW THEY REGAIN

2222
01:14:39,436 --> 01:14:41,171
WEIGHT BUT THE POINT YOU JUST

2223
01:14:41,171 --> 01:14:43,340
SAID WHICH I TRIED TO MAKE IS TO

2224
01:14:43,340 --> 01:14:46,210
ME IT'S GETTING PEOPLE TO STICK

2225
01:14:46,210 --> 01:14:48,178
WITH THE PROGRAM FOR NINE MONTHS

2226
01:14:48,178 --> 01:14:48,745
OR TWELVE MONTHS.

2227
01:14:48,745 --> 01:14:51,548
IF YOU DO THAT EVEN 18 YEARS

2228
01:14:51,548 --> 01:14:52,883
LATER THAT BENEFIT, METABOLIC

2229
01:14:52,883 --> 01:14:54,384
MEMORY, IT'S STILL GOING TO BE

2230
01:14:54,384 --> 01:14:54,585
THERE.

2231
01:14:54,585 --> 01:14:56,386
THE RISK IS STILL LOWER.

2232
01:14:56,386 --> 01:14:58,322
SO, I THINK WE KNOW THAT IF

2233
01:14:58,322 --> 01:15:01,191
PEOPLE LEAVE THIS PROGRAM, IF

2234
01:15:01,191 --> 01:15:03,560
YOU GO BACK THREE, FOUR, FIVE

2235
01:15:03,560 --> 01:15:06,096
YEARS, MAY GAIN WEIGHT, MAY NOT

2236
01:15:06,096 --> 01:15:07,297
BE DOING LIFESTYLE, IDEALLY THEY

2237
01:15:07,297 --> 01:15:08,966
WOULD BE BUT THE KEY IS DO THE

2238
01:15:08,966 --> 01:15:09,700
INTERVENTION THE WAY YOU'RE

2239
01:15:09,700 --> 01:15:11,468
SUPPOSED TO IN THAT FIRST YEAR.

2240
01:15:11,468 --> 01:15:14,104
IN TERMS OF KIDS, I'M NOT A

2241
01:15:14,104 --> 01:15:14,438
PEDIATRICIAN.

2242
01:15:14,438 --> 01:15:15,739
MY KNOWLEDGE OF HEALTH IN KIDS

2243
01:15:15,739 --> 01:15:17,608
IS LIMITED TO MY OWN THREE KIDS,

2244
01:15:17,608 --> 01:15:19,476
WHEN I GO TO THE DOCTOR.

2245
01:15:19,476 --> 01:15:22,679
BUT I WILL SAY FOR MY PATIENTS,

2246
01:15:22,679 --> 01:15:24,848
JUST MY BELIEF, I THINK WE FOCUS

2247
01:15:24,848 --> 01:15:26,383
ON FRUIT AS AN ISSUE.

2248
01:15:26,383 --> 01:15:28,018
PATIENTS SAY CAN I EAT THIS

2249
01:15:28,018 --> 01:15:29,152
FRUIT OR THAT FRUIT, I DON'T

2250
01:15:29,152 --> 01:15:31,188
THINK IT'S A GOOD IDEA AND SUCH

2251
01:15:31,188 --> 01:15:33,824
BUT SO MUCH IS ULTRA PROCESSED

2252
01:15:33,824 --> 01:15:34,024
FOOD.

2253
01:15:34,024 --> 01:15:36,793
AN ARTICLE I READ BETWEEN

2254
01:15:36,793 --> 01:15:37,394
TODAY'S SESSIONS ABOUT BIG NEW

2255
01:15:37,394 --> 01:15:40,297
STUDY IF YOU LOOK AT THE

2256
01:15:40,297 --> 01:15:41,698
WASHINGTON POST TODAY ULTRA

2257
01:15:41,698 --> 01:15:44,001
PROCESSED FOODS, WHAT THOSE ARE

2258
01:15:44,001 --> 01:15:46,303
DOING, HOT DOGS, CHIPS, THESE

2259
01:15:46,303 --> 01:15:47,271
ARE THE THINGS.

2260
01:15:47,271 --> 01:15:49,072
THE ORANGES AND FRUIT TO ME ARE

2261
01:15:49,072 --> 01:15:49,473
FINE.

2262
01:15:49,473 --> 01:15:51,141
I TELL PEOPLE THAT'S GREAT.

2263
01:15:51,141 --> 01:15:52,109
KNOCK YOURSELF OUT.

2264
01:15:52,109 --> 01:15:55,212
WE HAVE TO TALK MORE ABOUT ULTRA

2265
01:15:55,212 --> 01:15:57,481
PROCESSED FOODS BASICALLY JUST

2266
01:15:57,481 --> 01:16:01,118
FATS AND CARBS AND SUBSTITUTES.

2267
01:16:01,118 --> 01:16:01,451
ATTITUDE.

2268
01:16:01,451 --> 01:16:02,819
THAT'S WHERE THE PROBLEM IS

2269
01:16:02,819 --> 01:16:07,791
GOING, WE NEED TO WORK ON THAT.

2270
01:16:07,791 --> 01:16:09,326
>> YEAH, ONE OF THE
QUALITY OF

2271
01:16:09,326 --> 01:16:10,961
THE FOODS, NOT JUST QUANTITY,

2272
01:16:10,961 --> 01:16:12,729
YOU CAN'T LOSE WEIGHT UNLESS YOU

2273
01:16:12,729 --> 01:16:13,397
EAT LESS, RIGHT?

2274
01:16:13,397 --> 01:16:15,032
THAT'S AN ABSOLUTE.

2275
01:16:15,032 --> 01:16:17,334
NO EXERCISE IS GOING TO BE

2276
01:16:17,334 --> 01:16:17,701
SUFFICIENT.

2277
01:16:17,701 --> 01:16:21,705
AND THE QUALITY OF WHAT YOU EAT,

2278
01:16:21,705 --> 01:16:23,040
CAN BE SATISFYING, FULFILLING,

2279
01:16:23,040 --> 01:16:24,241
NUTRITION WITHOUT JUST BEING A

2280
01:16:24,241 --> 01:16:28,412
LOT OF EMPTY CALORIES.

2281
01:16:28,412 --> 01:16:36,320
ULTRA PROCESSED FOOD IS WORST 

2282
01:16:36,320 --> 01:16:40,691
CULPRIT BUT MANY TIMES LEAST

2283
01:16:40,691 --> 01:16:41,458
EXPENSIVE AND EASIEST.

2284
01:16:41,458 --> 01:16:43,360
WE HAVE TO KEEP WORKING.

2285
01:16:43,360 --> 01:16:44,628
THERE'S A LOT OF STRUCTURAL

2286
01:16:44,628 --> 01:16:47,130
FACTORINGS THAT CONTRIBUTE TO

2287
01:16:47,130 --> 01:16:48,332
THIS.

2288
01:16:48,332 --> 01:16:50,500
AND SOME OF THAT IS BASED ON

2289
01:16:50,500 --> 01:16:53,804
FOOD INDUSTRY, BASED ON

2290
01:16:53,804 --> 01:16:55,872
NEIGHBORHOODS, AND BASED ON

2291
01:16:55,872 --> 01:16:58,075
ECONOMIC RESOURCES THAT FAMILIES

2292
01:16:58,075 --> 01:16:58,275
HAVE.

2293
01:16:58,275 --> 01:17:02,112
>> ONE THING ABOUT THE
COOKING,

2294
01:17:02,112 --> 01:17:04,615
I HAVE TO SAY THE OTHER THING

2295
01:17:04,615 --> 01:17:06,817
THAT'S CHANGED, ALONG WITH

2296
01:17:06,817 --> 01:17:08,018
WEIGHT IS COOKING.

2297
01:17:08,018 --> 01:17:10,754
I THINK PEOPLE HONESTLY HAVE

2298
01:17:10,754 --> 01:17:15,559
FORGOTTEN HOW TO COOK, IN BROAD

2299
01:17:15,559 --> 01:17:16,059
TERMS.

2300
01:17:16,059 --> 01:17:17,427
IT'S NOT SO EASY.

2301
01:17:17,427 --> 01:17:19,062
YOU HAVE TO BALANCE, I'M

2302
01:17:19,062 --> 01:17:20,163
COOKING, I NEED THESE

2303
01:17:20,163 --> 01:17:21,498
INGREDIENTS, HAVE TO BUY THEM, I

2304
01:17:21,498 --> 01:17:24,334
DON'T BUY TOO MUCH SO IT GOES

2305
01:17:24,334 --> 01:17:26,169
BAD OR TOO LITTLE SO I CAN'T

2306
01:17:26,169 --> 01:17:27,404
FINISH THE MEAL, GET BACK,

2307
01:17:27,404 --> 01:17:30,007
FIGURE OUT HOW TO COOK IT, STORE

2308
01:17:30,007 --> 01:17:30,340
IT, ALL THAT.

2309
01:17:30,340 --> 01:17:32,409
FOR A LOT OF PEOPLE IT'S NOT

2310
01:17:32,409 --> 01:17:34,144
EVEN JUST -- IT'S THE TIME,

2311
01:17:34,144 --> 01:17:36,613
PRICE, THE MENTAL THOUGHT ABOUT

2312
01:17:36,613 --> 01:17:36,847
COOKING.

2313
01:17:36,847 --> 01:17:42,619
YOU CAN'T JUST PUT RAN DO  --

2314
01:17:42,619 --> 01:17:45,789
RANDOM STUFF IN YOUR CART.

2315
01:17:45,789 --> 01:17:47,891
A CHEF, HOW DO WE TEACH PEOPLE

2316
01:17:47,891 --> 01:17:51,495
ALL THE STEPS IN PREPARING,

2317
01:17:51,495 --> 01:17:52,796
BUDGETING, COOKING, AT UCLA WE

2318
01:17:52,796 --> 01:17:54,131
HAVE A TEST KITCHEN.

2319
01:17:54,131 --> 01:17:56,299
NOT ME BUT OTHER COLLEAGUES ARE

2320
01:17:56,299 --> 01:17:57,300
WORKING ON THOSE VERY ISSUES.

2321
01:17:57,300 --> 01:17:59,036
PART OF THE PROBLEM IS WE JUST

2322
01:17:59,036 --> 01:17:59,903
DON'T COOK ENOUGH.

2323
01:17:59,903 --> 01:18:01,571
IF WE WERE TO COOK MORE AT HOME

2324
01:18:01,571 --> 01:18:03,840
I THINK THESE THINGS WOULD ALSO

2325
01:18:03,840 --> 01:18:04,207
IMPROVE.

2326
01:18:04,207 --> 01:18:05,709
THAT'S ANOTHER AREA OF ACTIVE

2327
01:18:05,709 --> 01:18:09,346
WORK.

2328
01:18:09,346 --> 01:18:09,713
>> ABSOLUTELY.

2329
01:18:09,713 --> 01:18:11,748
AND LINKED TO THAT, YOU KNOW,

2330
01:18:11,748 --> 01:18:15,052
POSTDOCTORAL FELLOW IN MY LAB,

2331
01:18:15,052 --> 01:18:17,788
NUTRITIONIST, Ph.D., SORT OF

2332
01:18:17,788 --> 01:18:21,158
THE ROLE OF TRADITIONAL FOODS.

2333
01:18:21,158 --> 01:18:23,360
FOR EXAMPLE, IN THE LATINO --

2334
01:18:23,360 --> 01:18:26,063
MOST LATINO COUNTRIES, NOT ALL,

2335
01:18:26,063 --> 01:18:30,267
HAVING MORE PULSES OR LEGUMES OR

2336
01:18:30,267 --> 01:18:32,669
BEANS ARE TRADITION, PEOPLE IN

2337
01:18:32,669 --> 01:18:35,072
THIS COUNTRY WHEN THEY BECOME

2338
01:18:35,072 --> 01:18:37,908
EITHER MORE ACCULTURATED, LESS

2339
01:18:37,908 --> 01:18:40,377
ORIENTED LATINO CULTURE, THEY

2340
01:18:40,377 --> 01:18:41,511
ABANDON THAT, CONSUME MUCH LESS

2341
01:18:41,511 --> 01:18:42,846
OF THAT.

2342
01:18:42,846 --> 01:18:45,348
SIMILAR KIND OF PATTERNS CAN BE

2343
01:18:45,348 --> 01:18:49,186
FOUND FOR OTHER IMMIGRANT

2344
01:18:49,186 --> 01:18:50,053
POPULATIONS.

2345
01:18:50,053 --> 01:18:51,588
MEXICO HAS NOW THE HIGHEST

2346
01:18:51,588 --> 01:18:54,324
OBESITY RATE IN THE WORLD.

2347
01:18:54,324 --> 01:18:55,325
IT PASSED THE UNITED STATES.

2348
01:18:55,325 --> 01:18:57,594
AND OF COURSE THEY ALSO HAVE THE

2349
01:18:57,594 --> 01:18:59,696
HIGHEST RATE OF DIABETES IN THE

2350
01:18:59,696 --> 01:19:00,664
WORLD.

2351
01:19:00,664 --> 01:19:02,632
AND THEY HAVE DONE SOME MORE

2352
01:19:02,632 --> 01:19:07,003
INTERVENTIONS ON THE STRUCTURAL

2353
01:19:07,003 --> 01:19:08,872
SIDE WITH SUGAR-SWEETENED

2354
01:19:08,872 --> 01:19:09,740
BEVERAGES AND TAXES.

2355
01:19:09,740 --> 01:19:11,942
BUT THIS IS A GLOBAL PROBLEM,

2356
01:19:11,942 --> 01:19:14,644
IT'S JUST NOT A HIGH INCOME

2357
01:19:14,644 --> 01:19:15,879
COUNTRY PROBLEM ONLY.

2358
01:19:15,879 --> 01:19:17,514
NEXT QUESTION, IS THERE ANY

2359
01:19:17,514 --> 01:19:20,250
MOVEMENT IN THE FIELD TO FOCUS

2360
01:19:20,250 --> 01:19:21,985
ON CHANGING CLUSTERED LIFESTYLE

2361
01:19:21,985 --> 01:19:23,420
BEHAVIORS WHICH PLACE

2362
01:19:23,420 --> 01:19:24,621
INDIVIDUALS AT RISK FOR

2363
01:19:24,621 --> 01:19:25,088
DIABETES?

2364
01:19:25,088 --> 01:19:28,692
NOT SURE WHAT IS MEANT BY

2365
01:19:28,692 --> 01:19:29,459
CLUSTERED LIFESTYLE BEHAVIORS

2366
01:19:29,459 --> 01:19:31,194
BUT MAYBE YOU DO?

2367
01:19:31,194 --> 01:19:33,063
>> NO, I'M NOT SURE IF
THAT

2368
01:19:33,063 --> 01:19:36,233
MEANS ACTIVITY AND DIET TOGETHER

2369
01:19:36,233 --> 01:19:39,169
MAYBE, LIKE WORSE DIET AND LESS

2370
01:19:39,169 --> 01:19:40,504
ACTIVITY.

2371
01:19:40,504 --> 01:19:41,872
>> CAN WE GET
CLARIFICATION?

2372
01:19:41,872 --> 01:19:43,440
THAT WILL HELP.

2373
01:19:43,440 --> 01:19:45,609
WHILE WE WAIT, EXCELLENT

2374
01:19:45,609 --> 01:19:47,377
PRESENTATION, CONGRATULATIONS TO

2375
01:19:47,377 --> 01:19:49,713
DR. DURU, HAS THE INFLUENCE OF

2376
01:19:49,713 --> 01:19:52,215
AFFORDABILITY ON HEALTH CARE

2377
01:19:52,215 --> 01:19:54,084
FOOD CHOICES BEEN STUDIED IN

2378
01:19:54,084 --> 01:19:56,486
RELEVANCE TO DPP?

2379
01:19:56,486 --> 01:19:57,788
ALSO ARE THERE CORRELATIVE

2380
01:19:57,788 --> 01:20:01,358
STUDIES IN PATIENTS WHO ARE

2381
01:20:01,358 --> 01:20:03,994
REFRACTORY TO METFORMIN AND/OR

2382
01:20:03,994 --> 01:20:05,128
OTHER THERAPIES?

2383
01:20:05,128 --> 01:20:06,863
>> YES, THERE HAS BEEN A
LOT OF

2384
01:20:06,863 --> 01:20:08,431
ATTENTION PAID TO THE DPP, WHAT

2385
01:20:08,431 --> 01:20:09,432
PEOPLE ARE ABLE TO EAT.

2386
01:20:09,432 --> 01:20:10,934
IF YOU HAVE ALL THESE SESSIONS

2387
01:20:10,934 --> 01:20:12,369
ABOUT COOKING FOOD AND PEOPLE

2388
01:20:12,369 --> 01:20:13,804
CAN'T AFFORD TO BUY FOOD YOU'RE

2389
01:20:13,804 --> 01:20:15,105
TALKING ABOUT, OR THE FOOD

2390
01:20:15,105 --> 01:20:16,072
YOU'RE TALKING ABOUT IS NOT WHAT

2391
01:20:16,072 --> 01:20:18,708
THEY LIKE TO EAT IT'S GOING TO

2392
01:20:18,708 --> 01:20:20,076
BE A PROBLEM.

2393
01:20:20,076 --> 01:20:23,547
I'LL JUST SAY THE BIGGEST

2394
01:20:23,547 --> 01:20:25,916
PROBLEM, A LOT OF INDIVIDUALS,

2395
01:20:25,916 --> 01:20:27,517
SPOUSE DOESN'T WANT TO EAT THE

2396
01:20:27,517 --> 01:20:29,719
FOOD THEY EAT, OR THE KIDS DON'T

2397
01:20:29,719 --> 01:20:32,322
WANT TO EAT THE FOOD.

2398
01:20:32,322 --> 01:20:34,090
IT'S HARD TO COOK TWO MEALS

2399
01:20:34,090 --> 01:20:36,726
EVERY DAY, ONE FOR THEMSELVES

2400
01:20:36,726 --> 01:20:38,261
HEALTHY AND ONE FOR THE KIDS

2401
01:20:38,261 --> 01:20:39,696
YELLING BECAUSE THEY WANT HOT

2402
01:20:39,696 --> 01:20:40,764
DOGS AND FRENCH FRIES.

2403
01:20:40,764 --> 01:20:42,866
THAT'S ALSO PART OF IT WITHIN

2404
01:20:42,866 --> 01:20:44,034
YOUR OWN HOUSEHOLD TRYING TO

2405
01:20:44,034 --> 01:20:45,402
FIGURE OUT HOW TO DO THIS.

2406
01:20:45,402 --> 01:20:47,470
THERE WAS ANOTHER PART OF THE

2407
01:20:47,470 --> 01:20:51,274
QUESTION, I JUST FORGOT IT.

2408
01:20:51,274 --> 01:20:52,542
>> CORRELATIVE STUDIES IN

2409
01:20:52,542 --> 01:20:54,477
PATIENTS REFRACTORY TO

2410
01:20:54,477 --> 01:20:59,015
METFORMIN. 

2411
01:20:59,015 --> 01:21:01,184
>> THAT'S RIGHT.

2412
01:21:01,184 --> 01:21:01,952
WELL, REFRACTORY TO METFORMIN,

2413
01:21:01,952 --> 01:21:03,153
IT'S HARD TO KNOW WHAT THAT

2414
01:21:03,153 --> 01:21:04,154
MEANS.

2415
01:21:04,154 --> 01:21:07,424
A LOT OF PEOPLE CAN'T TOLERATE

2416
01:21:07,424 --> 01:21:07,757
METFORMIN.

2417
01:21:07,757 --> 01:21:10,360
SOME PEOPLE CAN'T BECAUSE OF

2418
01:21:10,360 --> 01:21:11,928
NAUSEA, VOMITING, G.I. SIDE

2419
01:21:11,928 --> 01:21:13,096
EFFECTS THAT ARE TRANSIENT BUT

2420
01:21:13,096 --> 01:21:15,532
SOME PEOPLE NEVER TAKE IT AGAIN

2421
01:21:15,532 --> 01:21:17,500
AFTER THEY EXPERIENCE THOSE.

2422
01:21:17,500 --> 01:21:18,802
PEOPLE WHO MAKE METFORMIN AND

2423
01:21:18,802 --> 01:21:21,238
DON'T ACHIEVE THE GOAL THEY

2424
01:21:21,238 --> 01:21:23,306
WANT, WITH METFORMIN IT'S A

2425
01:21:23,306 --> 01:21:24,474
MEDICATION FOR DIABETES ANYWAY,

2426
01:21:24,474 --> 01:21:25,809
THE FIRST LINE.

2427
01:21:25,809 --> 01:21:27,878
IF YOU START IT AND THEY

2428
01:21:27,878 --> 01:21:28,879
PROGRESS TO DIABETES YOU WOULD

2429
01:21:28,879 --> 01:21:31,514
ADD SOMETHING ELSE ON TOP OF IT.

2430
01:21:31,514 --> 01:21:33,083
THERE ARE MULTIPLE NIH STUDIES

2431
01:21:33,083 --> 01:21:35,118
THAT GIVE GUIDELINES OF WHAT TO

2432
01:21:35,118 --> 01:21:35,318
DO.

2433
01:21:35,318 --> 01:21:44,527
I THINK NO ONE HAS TALKED ABOUT

2434
01:21:44,527 --> 01:21:47,831
YET OZEMPIC.

2435
01:21:47,831 --> 01:21:50,433
>> NEXT QUESTION.

2436
01:21:50,433 --> 01:21:53,303
DO YOU THINK THAT WILL AFFECT

2437
01:21:53,303 --> 01:21:55,805
TRAJECTORY OF DIABETES

2438
01:21:55,805 --> 01:21:56,106
DISPARITIES?

2439
01:21:56,106 --> 01:22:01,011
>> THIS IS GOING TO BE A
BIG

2440
01:22:01,011 --> 01:22:03,346
ISSUE BECAUSE, YOU KNOW, THE

2441
01:22:03,346 --> 01:22:04,681
MEDICATIONS ARE EXPENSIVE AND

2442
01:22:04,681 --> 01:22:05,949
NOT ALWAYS COVERED, IF THEY ARE

2443
01:22:05,949 --> 01:22:07,984
COVERED IT'S A LOT OF HOOPS TO

2444
01:22:07,984 --> 01:22:09,185
JUMP THROUGH AND MANY PATIENTS

2445
01:22:09,185 --> 01:22:11,621
OF COLOR MAY BE IN SETTINGS

2446
01:22:11,621 --> 01:22:13,156
WHERE THEY DON'T GET THOSE,

2447
01:22:13,156 --> 01:22:15,525
PROVIDERS WON'T DO THAT.

2448
01:22:15,525 --> 01:22:17,160
I'LL GIVE L.A. COUNTY CREDIT

2449
01:22:17,160 --> 01:22:19,129
BECAUSE THEY HAVE MADE THE BOLD

2450
01:22:19,129 --> 01:22:24,167
STEP ANYONE WITH DIABETES IN

2451
01:22:24,167 --> 01:22:28,038
L.A. COUNTY SAFETY NET SYSTEMS

2452
01:22:28,038 --> 01:22:28,939
CAN GET OZEMPIC COVERED.

2453
01:22:28,939 --> 01:22:32,075
WE'RE GOING TO SEE IF THIS MAKES

2454
01:22:32,075 --> 01:22:33,843
A DIFFERENCE IN REDUCING WEIGHT

2455
01:22:33,843 --> 01:22:36,012
AND DIABETES ACROSS THE SAFETY

2456
01:22:36,012 --> 01:22:37,647
NET HEALTH SYSTEM.

2457
01:22:37,647 --> 01:22:39,115
THE HOPE IS THOSE STUDIES,

2458
01:22:39,115 --> 01:22:41,151
HOPEFULLY IF THERE IS A BENEFIT,

2459
01:22:41,151 --> 01:22:43,219
CAN LEAD THE WAY TO GREATER USE

2460
01:22:43,219 --> 01:22:46,523
BUT IN THE SHORT TERM I'M VERY

2461
01:22:46,523 --> 01:22:48,291
WORRIED WE'LL SEE WORSENING OF

2462
01:22:48,291 --> 01:22:49,592
DISPARITIES IF WE DON'T DO

2463
01:22:49,592 --> 01:22:51,027
SOMETHING BECAUSE WEIGHT LOSS

2464
01:22:51,027 --> 01:22:54,864
PEOPLE SEE IT'S GOING TO AFFECT

2465
01:22:54,864 --> 01:22:56,499
DIABETES INCIDENCE.

2466
01:22:56,499 --> 01:22:59,402
IT'S NOT REALLY APPROVED FOR

2467
01:22:59,402 --> 01:22:59,903
PREDIABETES YET.

2468
01:22:59,903 --> 01:23:00,737
MAY BE.

2469
01:23:00,737 --> 01:23:01,304
WE'LL SEE.

2470
01:23:01,304 --> 01:23:05,175
A LOT OF PEOPLE AT RISK ARE

2471
01:23:05,175 --> 01:23:06,609
CLAMORING TO GET IT, AND WE

2472
01:23:06,609 --> 01:23:08,144
BELIEVE THE RISK OF DIABETES

2473
01:23:08,144 --> 01:23:09,145
WILL BE LESS.

2474
01:23:09,145 --> 01:23:11,114
ANY NEW TECHNOLOGY OR MED THAT'S

2475
01:23:11,114 --> 01:23:12,082
EXPENSIVE, IT'S A REAL CHALLENGE

2476
01:23:12,082 --> 01:23:14,818
TO FIGURE OUT HOW TO ALLOW

2477
01:23:14,818 --> 01:23:16,686
EQUITABLE ACCESS AND USE, WE'RE

2478
01:23:16,686 --> 01:23:19,522
STILL WORKING ON THAT.

2479
01:23:19,522 --> 01:23:19,856
>> RIGHT.

2480
01:23:19,856 --> 01:23:23,793
I'M NOT AS TUNED IN TO THE

2481
01:23:23,793 --> 01:23:26,529
CLINICAL NUANCES HERE BUT I

2482
01:23:26,529 --> 01:23:28,832
PERSONALLY AM SKEPTICAL ABOUT

2483
01:23:28,832 --> 01:23:30,166
THESE NEW RAGE DRUGS.

2484
01:23:30,166 --> 01:23:31,901
BUT YOU NEVER KNOW.

2485
01:23:31,901 --> 01:23:34,070
WE'LL SEE IF SOME WILL PAN OUT.

2486
01:23:34,070 --> 01:23:37,474
THE FACT THAT THEY ARE SO

2487
01:23:37,474 --> 01:23:41,077
EXPENSIVE MAKES IT LIKELY THEY

2488
01:23:41,077 --> 01:23:42,612
WILL WORSEN DISPARITIES MORE

2489
01:23:42,612 --> 01:23:43,813
LIKELY THAN IMPROVE THEM BUT

2490
01:23:43,813 --> 01:23:45,382
IT'S STILL A DRUG THAT PEOPLE

2491
01:23:45,382 --> 01:23:50,720
HAVE TO TAKE SO ADHERENCE IS A

2492
01:23:50,720 --> 01:23:50,987
BIG ISSUE.

2493
01:23:50,987 --> 01:23:52,455
AND I THINK A LOT OF PEOPLE

2494
01:23:52,455 --> 01:23:55,625
STILL ARE LOOKING FOR A MAGIC

2495
01:23:55,625 --> 01:23:59,029
BULLET, AND IN FACT WE KNOW WE

2496
01:23:59,029 --> 01:24:00,130
HAVE BEHAVIORAL INTERVENTIONS

2497
01:24:00,130 --> 01:24:02,766
THAT WORK, IN FACT IF YOU WANT

2498
01:24:02,766 --> 01:24:08,338
TO GET MORE INVASIVE BARIATRIC

2499
01:24:08,338 --> 01:24:10,440
SURGERY HAS CLEAR BENEFITS, DONE

2500
01:24:10,440 --> 01:24:14,811
WITH MUCH LESS ADVERSE EFFECTS

2501
01:24:14,811 --> 01:24:15,178
NOWADAYS.

2502
01:24:15,178 --> 01:24:21,351
I THINK WE'LL THROW IN DO YOU

2503
01:24:21,351 --> 01:24:23,119
THINK SCREENING, I THOUGHT IT

2504
01:24:23,119 --> 01:24:26,489
WAS ROUTINE ALL WOMEN WOULD BE

2505
01:24:26,489 --> 01:24:28,024
SCREENED EARLY IN PREGNANCY,

2506
01:24:28,024 --> 01:24:30,260
WHAT USUALLY HAPPENS 12 TO 16

2507
01:24:30,260 --> 01:24:30,994
WEEKS, RIGHT?

2508
01:24:30,994 --> 01:24:31,361
>> YEAH.

2509
01:24:31,361 --> 01:24:33,296
>> 18 OR SOMETHING LIKE
THAT?

2510
01:24:33,296 --> 01:24:35,465
>> LATER, THAT'S RIGHT.

2511
01:24:35,465 --> 01:24:37,133
>> AND MANAGING GDM WOULD
HELP

2512
01:24:37,133 --> 01:24:40,703
REDUCE INCIDENCE OF TYPE 2 IN

2513
01:24:40,703 --> 01:24:42,038
RACIAL MINORITIES?

2514
01:24:42,038 --> 01:24:43,339
>> WELL, I'LL SAY EVERY OB
I

2515
01:24:43,339 --> 01:24:44,474
KNOW, THEY ARE SERIOUS ABOUT

2516
01:24:44,474 --> 01:24:45,775
THIS FOR GOOD REASON.

2517
01:24:45,775 --> 01:24:46,876
THEY TAKE IT PERSONALLY THEY

2518
01:24:46,876 --> 01:24:48,845
HAVE TO PROTECT THIS MOTHER AND

2519
01:24:48,845 --> 01:24:49,379
THE BABY.

2520
01:24:49,379 --> 01:24:55,085
AND ANYONE THAT GOES TO PRENATAL

2521
01:24:55,085 --> 01:24:56,486
CARE GETS THIS.

2522
01:24:56,486 --> 01:24:59,789
SOME WOMAN ARE NOT CONNECT WITH

2523
01:24:59,789 --> 01:25:02,192
THE CARE, AREN'T SCREENED,

2524
01:25:02,192 --> 01:25:02,792
COMPLICATED DELIVERY BECAUSE

2525
01:25:02,792 --> 01:25:04,160
IT'S NOT CONTROLLED.

2526
01:25:04,160 --> 01:25:06,996
FETUS GETS LARGE BECAUSE OF

2527
01:25:06,996 --> 01:25:08,965
CIRCULATING SUGAR, PROBLEMS WITH

2528
01:25:08,965 --> 01:25:10,633
SHOULDER DISLOCATION AT BIRTH

2529
01:25:10,633 --> 01:25:11,267
AND WORSE COMPLICATIONS.

2530
01:25:11,267 --> 01:25:13,570
IF YOU GO TO PRENATAL CARE

2531
01:25:13,570 --> 01:25:14,771
YOU'LL GET THIS TEST, THEY WILL

2532
01:25:14,771 --> 01:25:16,206
MAKE SURE YOU GET IT.

2533
01:25:16,206 --> 01:25:20,110
I THINK IN TERMS OF PREVENTING

2534
01:25:20,110 --> 01:25:21,878
DIABETES, THE PROBLEM I'VE SEEN,

2535
01:25:21,878 --> 01:25:23,079
IT'S HARD TO INSTITUTE LIFESTYLE

2536
01:25:23,079 --> 01:25:25,415
CHANGE YOU WOULD LIKE AT THIS OF

2537
01:25:25,415 --> 01:25:26,249
THAT POINT.

2538
01:25:26,249 --> 01:25:27,484
FOCUS IS NOT NECESSARILY ON

2539
01:25:27,484 --> 01:25:28,918
LOSING WEIGHT, NOT THE WAY IT

2540
01:25:28,918 --> 01:25:31,321
SHOULD BE ON LOSING WEIGHT, BUT

2541
01:25:31,321 --> 01:25:33,256
IN ORDER TO PREVENT DIABETES

2542
01:25:33,256 --> 01:25:34,624
OVER LONGER TERM YOU HAVE TO

2543
01:25:34,624 --> 01:25:35,792
TALK ABOUT LOSING WEIGHT.

2544
01:25:35,792 --> 01:25:37,127
THAT'S NOT WHAT THEY FOCUS ON

2545
01:25:37,127 --> 01:25:37,660
FOR GOOD REASON.

2546
01:25:37,660 --> 01:25:39,429
I DON'T KNOW THAT MORE SCREENING

2547
01:25:39,429 --> 01:25:41,164
AND TREATMENT DURING PREGNANCY

2548
01:25:41,164 --> 01:25:43,800
WILL DO THINGS TO AFFECT TYPE 2

2549
01:25:43,800 --> 01:25:46,002
DIABETES BUT THE HOPE IS THERE'S

2550
01:25:46,002 --> 01:25:51,241
A LINK, YOU GO TO POST PART UM

2551
01:25:51,241 --> 01:25:51,875
SCREENING, GET CONNECTED WITH

2552
01:25:51,875 --> 01:25:53,877
PCP AND THEY PICK UP THE CHAIN

2553
01:25:53,877 --> 01:25:55,278
AND MOVE FORWARD ARE

2554
01:25:55,278 --> 01:25:56,813
TRANSITIONING TO WEIGHT LOSS

2555
01:25:56,813 --> 01:25:57,814
INTERVENTION FROM PREGNANCY

2556
01:25:57,814 --> 01:25:58,148
INTERVENTION.

2557
01:25:58,148 --> 01:26:01,417
SO WE HAVE TO DO A BETTER JOB

2558
01:26:01,417 --> 01:26:03,953
CONNECTING PEOPLE THROUGH THAT

2559
01:26:03,953 --> 01:26:04,988
PASSING THE BATON.

2560
01:26:04,988 --> 01:26:09,192
>> TO PUT NUMBERS ON IT,
IF YOU

2561
01:26:09,192 --> 01:26:11,427
KNOW THEM, PREDIABETES THE

2562
01:26:11,427 --> 01:26:13,496
NUMBER I REMEMBER IS 50% DEVELOP

2563
01:26:13,496 --> 01:26:15,999
DIABETES WITHIN TEN YEARS OR SO,

2564
01:26:15,999 --> 01:26:17,901
I DON'T KNOW IF IT'S STILL

2565
01:26:17,901 --> 01:26:23,840
CONSIDERED THAT HIGH OR IF IT'S 

2566
01:26:23,840 --> 01:26:25,041
EVEN LOWER.

2567
01:26:25,041 --> 01:26:26,442
IS GESTATIONAL DIABETES IN THE

2568
01:26:26,442 --> 01:26:27,877
SAME BALL PARK OR HIGHER?

2569
01:26:27,877 --> 01:26:29,179
>> THAT'S THE ONE THAT'S
IN THE

2570
01:26:29,179 --> 01:26:29,846
BALL PARK.

2571
01:26:29,846 --> 01:26:32,682
I'LL SAY THAT WE HAVE ANOTHER

2572
01:26:32,682 --> 01:26:35,084
COLLEAGUE AT TUFTS, A MODEL FROM

2573
01:26:35,084 --> 01:26:36,286
DPP THAT THERE'S NOT ONE RISK

2574
01:26:36,286 --> 01:26:37,487
FOR EVERYBODY.

2575
01:26:37,487 --> 01:26:39,122
THERE ARE 11 VARIABLES THAT

2576
01:26:39,122 --> 01:26:41,558
PREDICT YOUR RISK OF DIABETES,

2577
01:26:41,558 --> 01:26:44,594
A1c AND BMI ARE CHIEF BUT EVEN

2578
01:26:44,594 --> 01:26:47,230
CHOLESTEROL AND AGE AND RACE,

2579
01:26:47,230 --> 01:26:49,299
THOSE ARE THINGS, WE THINK

2580
01:26:49,299 --> 01:26:51,701
EVERYONE HAS THEIR OWN RISK, IF

2581
01:26:51,701 --> 01:26:53,469
YOU HAVE GDM YOU'RE AT THE

2582
01:26:53,469 --> 01:26:54,771
HIGHEST LEVEL OF TRANSITION

2583
01:26:54,771 --> 01:26:55,004
RATE.

2584
01:26:55,004 --> 01:26:56,506
>> GOOD TO KNOW.

2585
01:26:56,506 --> 01:26:58,174
WELL, WE'VE RUN OUT OF TIME.

2586
01:26:58,174 --> 01:27:00,677
THERE ARE QUESTIONS ABOUT THE

2587
01:27:00,677 --> 01:27:02,011
ROLE OF POLITICAL DETERMINANTS

2588
01:27:02,011 --> 01:27:06,482
BUT I THINK WE CAN DO THAT

2589
01:27:06,482 --> 01:27:06,716
OFFLINE.

2590
01:27:06,716 --> 01:27:10,320
AND THEN A QUESTION ON THE

2591
01:27:10,320 --> 01:27:11,487
RACE-BASED VERSUS RACE-NEUTRAL

2592
01:27:11,487 --> 01:27:13,056
CUT OFF, I THINK YOU'VE TALKED

2593
01:27:13,056 --> 01:27:15,592
ABOUT THIS BUT YOU WEREN'T SURE

2594
01:27:15,592 --> 01:27:16,793
WHAT THAT TASK FORCE WAS GOING

2595
01:27:16,793 --> 01:27:18,561
TO COME OUT ON.

2596
01:27:18,561 --> 01:27:19,195
>> THAT'S RIGHT.

2597
01:27:19,195 --> 01:27:21,297
>> AND GIVE YOU MY VIEWS,
THEY

2598
01:27:21,297 --> 01:27:22,265
SHOULD SCREEN EVERYBODY ABOVE A

2599
01:27:22,265 --> 01:27:25,101
CERTAIN AGE AND NOT BOTHER WITH

2600
01:27:25,101 --> 01:27:26,202
BMI OR RACE.

2601
01:27:26,202 --> 01:27:28,404
BUT ANY LAST COMMENTS ON IT?

2602
01:27:28,404 --> 01:27:29,138
>> NO.

2603
01:27:29,138 --> 01:27:30,473
I DON'T KNOW THAT -- LET'S WAIT

2604
01:27:30,473 --> 01:27:32,242
AND SEE WHAT THE TASK FORCE

2605
01:27:32,242 --> 01:27:32,742
SAYS.

2606
01:27:32,742 --> 01:27:35,278
>> AREN'T YOU ON THE TASK
FORCE?

2607
01:27:35,278 --> 01:27:36,579
>> NO, NO, I HAVE NOT YET
BEEN.

2608
01:27:36,579 --> 01:27:38,681
MAYBE ONE DAY I'LL BE HONORED

2609
01:27:38,681 --> 01:27:40,350
ENOUGH TO JOIN.

2610
01:27:40,350 --> 01:27:41,951
BUT NOT AS YET.

2611
01:27:41,951 --> 01:27:43,286
>> OKAY.

2612
01:27:43,286 --> 01:27:45,855
>> AS EVERYONE HERE KNOWS,
THE

2613
01:27:45,855 --> 01:27:47,123
RACE-BASED THING, THERE'S A LOT

2614
01:27:47,123 --> 01:27:49,559
OF MOVEMENT, WE'LL SEE WHERE IT

2615
01:27:49,559 --> 01:27:49,993
ENDS UP.

2616
01:27:49,993 --> 01:27:53,162
I WANT TO MAKE SURE WE DO THINGS

2617
01:27:53,162 --> 01:27:54,030
THAT REDUCE DISPARITIES.

2618
01:27:54,030 --> 01:27:55,765
IF THEY DO, I'M FOR THEM.

2619
01:27:55,765 --> 01:27:58,301
BUT IT'S A COMPLICATED THING TO

2620
01:27:58,301 --> 01:28:00,036
SORT OUT.

2621
01:28:00,036 --> 01:28:00,803
>> KENRIK, THANK YOU FOR
THE

2622
01:28:00,803 --> 01:28:03,339
TIME YOU SPENT WITH US, BOTH

2623
01:28:03,339 --> 01:28:06,175
EARLIER WITH MEET AND GREET AND

2624
01:28:06,175 --> 01:28:09,579
THIS AFTERNOON, IN THIS TALK.

2625
01:28:09,579 --> 01:28:12,081
IT WAS TIMELY TIME TO GO OVER A

2626
01:28:12,081 --> 01:28:15,418
LOT OF ISSUES WITH DIABETES, AND

2627
01:28:15,418 --> 01:28:16,953
PARTICULARLY FOR OUR AUDIENCE.

2628
01:28:16,953 --> 01:28:18,554
AND SO, AGAIN, THANK YOU FOR

2629
01:28:18,554 --> 01:28:20,423
YOUR WONDERFUL TALK.

2630
01:28:20,423 --> 01:28:21,724
>> PERFECT, THANKS TO ALL
OF YOU

2631
01:28:21,724 --> 01:28:23,459
FOR YOUR ATTENTION.

2632
01:28:23,459 --> 01:28:24,327
HAVE A WONDERFUL AFTERNOON,

2633
01:28:24,327 --> 01:28:26,763
WONDERFUL WEEKEND.

2634
01:28:26,763 --> 01:28:27,297
>> TAKE CARE.

2635
01:28:27,297 --> 01:28:27,530
BYE-BYE.

2636
01:28:27,530 --> 01:28:30,166
[END OF PROGRAM]

2637
01:28:30,166 --> 01:28:36,172
 

2638
01:28:36,172 --> 01:28:46,215