How Robotic Surgery Transforms Patient Care: Insights from Fortis Experts

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And I think you're going to love it. Welcome to Your Diabesti, the podcast that ensures you never have to do diabetes alone. I'm your host, Mila Clark. Today, we are talking about type 2 diabetes and cardiovascular disease. I talked to Dr. Devin Steenkamp, an endocrinologist with Boston University, Chobanian and Avedisian School of Medicine. And we had a great conversation about the risks of T2D, of the risks of cardiovascular disease in T2D. Factors that increase a person's risk for heart disease and stroke. And how can you turn things around if you learn that you have increased risk? This session was developed by MedIQ and Boston University's Chobanian and Avedisian School of Medicine through an educational grant from Novo Nordisk. I hope you enjoy listening. Don't forget, there is a survey you can take to share your experience about diabetes. It'll allow you to be entered into a giveaway for a $100 gift card. I hope that you get your questions about type 2 diabetes and cardiovascular disease answered. Now, on to the conversation. I love it when we can get an endo on board to really talk about these things that are very real to us. My connection to type 2 diabetes and cardiovascular disease is my mother, who unfortunately passed away about two years ago from sclerosis. And she had a heart attack. It was very sudden. It was something that we weren't expecting. And she had been living with diabetes for over 25 years. It was really something that was a bit of a shock to us. And so now, really within my family, we're constantly talking about monitoring your heart. We're constantly talking about making sure you know your vitals, your blood pressure, making sure that your diet is on point. But we're going to talk about all of that tonight with an amazing, amazing guest. Our guest is Dr. Steenkamp. Thank you for having me, Mila. What do people living with type 2 diabetes need to know about the increased risk that they might have for cardiovascular disease and particularly heart disease and stroke? Yeah, so unfortunately, type 2 diabetes has been regarded as a cardiovascular risk equivalent, meaning that people with type 2 diabetes have a significantly increased risk of developing cardiovascular disease, predominantly heart attacks and strokes. And that risk varies from individual to individual. It's not the same for everybody. But generally, it's reported to be two to four times an increased risk in the general population. There's a couple of reasons for that, which we'll unpack as we go through the session. But there is an increased risk. Yeah, absolutely. I would love to know why. Why does, why is that risk so varied? And you know, why is it like that two to four times risk living with the condition? It's relatively complex, which is why there's such a variance between that two to four. Some person may be at a higher or lower risk. Diabetes, being exposed to high glucose over a long period of type 2 diabetes is not a short term condition, increases the risk of a variety of other associated combinations and conditions that we loosely call the metabolic syndrome. So most folks with type 2 diabetes have an increased risk of blood pressure and cholesterol. Many are overweight or struggling with obesity. There's also an increased risk of blood clotting. They're more prone to clotting, which is a risk factor for heart attacks and strokes, increased chronic inflammation in blood vessels in people with type 2 diabetes. When you put all of those pieces together, all of these conditions individually increase the risk. Cumulatively, there's an increased risk. Not everybody has all of those conditions together, but many people with type 2 diabetes live with some of them. You talked about factors that increase risk like metabolic syndrome, inflammation, diet, lifestyle choices can also contribute in terms of how much you move and get active and even like your saturated fat intake, all of these things that really kind of work all together. And I'm curious if it lowers the risk for a person with type 2 diabetes, if they're meeting their A1c and time and range goals. So yes, I think the simple answer is yes. For every 1% you lower your A1c, there's a significant reduction in the risk of developing microvascular complications, kidney problems, nerve problems, diabetic eye disease. And that's a major benefit of lowering your glucose. But there is also a benefit in lowering what we call the macrovascular risks, larger blood vessels that lower extremities and the brain. Most value in lowering glucose and lowering A1c and increasing the time and range is actually in reducing the risk in smaller blood vessels for the microvascular disease. I know from my family history that I've had an increased personal risk. How would your doctor help you determine that risk? And what questions should someone ask their doctor if they're worried about that risk? Understanding the risk factors that I mentioned before and knowing that these things tend to run together, so the conditions that I mentioned. Also, type 2 diabetes is pretty strongly inherited. So many people with type 2 diabetes have got multiple family members on both sides of the family in many cases who have that risk, as you just mentioned. And so understanding that and the type of diabetes that people have and at what age they were diagnosed. And then, as you mentioned already before, understanding the other factors that drive that in terms of lifestyle. So we'll talk more about that maybe later around the choices, your food, your exercise habits, just the way you generally live. Discussing with your doctor, what are the exercise recommendations? Can you be specific about what that means for me? I need to eat less fried food, but can you give me some more specific recommendations as to what may be a healthier diet? And I think we know that type 2 diabetes, the foundation of everything, is formed on the pillars of diet and exercise. And in medications, without exercise and a healthy diet, it's difficult to get the impact that you'd like with medications. So I think it's a combination of lifestyle, a combination of genetic risk, a combination of also parts of the world that you live in. We know that there are certain people and certain parts of the world where there's a significant risk of type 2 diabetes. Parts of the Pacific, Papua New Guinea, for example, parts of Southeast Asia, where people don't necessarily have to be as overweight or necessarily have to have as high of a body mass index as in other places. In the United States, body mass index of 30 is being what we regard as living with obesity. And in Southeast Asia, we start thinking about that level in the lower 20s. From the patient perspective, if you end up finding out that you do have this increased personal risk, should you be immediately worried? Or is it something workable over time with the right interventions? Yeah, that's something you need to be immediately worried about. Diabetes is a marathon, not a sprint. It's about sustainable change. Many of us can make short-term, very dramatic changes that are not sustainable because it makes us unhappy and we're miserable and we do things that are not sustainable. And so I think when we talk about risk, it's the same thing. A professor of mine years ago told me that we need to think of type 2 diabetes as the epilogue of a story. There's a long pre-history and the rest of the story before that. Pre-diabetes risk of developing type 2 diabetes is where we, as a field in medicine, have made the least impact. And really, as a community and as an individual, you can have the biggest impact, long-term impact. We know in many, many research studies that there's a variety of different interventions that we can do to either delay or significantly reduce the risk of developing type 2 diabetes. It's about sustainability over the long term. And that's the hard part. We're preachers of habit. We don't always do what we ideally like to do long-term. No reason to panic. Good. That's what I love to hear because I know getting a diabetes diagnosis, I remember when I was initially diagnosed, I had that immediate moment of panic and I was like, I don't know if this is something that I have to worry about right now at this second and change everything or if it's something I can work with over time. It is comforting to hear that it's not the end of the world if you do find out that you have that increased risk. It allows you to make better decisions about how to manage your health, which is important. I agree. I tell my patients to think about diabetes not as a disease or even pre-diabetes is clearly not a disease, but it's a risk factor for disease in the long term if certain conditions are met. We have a lot of power to intervene in avoiding those conditions. Some of them not. There are certain just things that are inherently biologically speaking about inflammation and blood vessels and those are not things that we can inherently change, but there's a lot of impact that we can prevent type 2 diabetes from becoming a condition that makes you sick. When you think about it from that perspective, it helps you say, I'm not sick as a result of being told that I have diabetes. I want to open it up to the audience so you can ask questions in the chat. We have a few minutes left before we hop to the next live at Dean Camp and answer some additional questions from other folks interviewing him tonight. One thing I would love to know from your perspective is how you work with your healthcare provider to ensure you're getting the right resources and you're asking the right questions to help with your management. I think it's a pretty simple answer. I think you have to just really be a good self-educator and I think that that's something I encourage in my patients, teach my kids and I think about it from my own perspective is your healthcare providers, they have your best intentions at heart, but they're stressed, they're busy, they're being asked to see lots of patients, they're running behind, they can be frazzled. You coming into that environment and saying, this is my agenda, how I'm going to advocate for myself and what I'm looking for, takes pressure off us because we want to meet your agenda. We may have our own side agenda, but we're happy and patients say, this is where I'm at and everybody's at a different phase and we may meet patients at different phases because this is a chronic condition. We need to be comfortable with having that open dialogue and relationship with patients and I think once you start developing that relationship, it creates a humanity to that relationship and then you just have this organic, it's not necessarily, I wouldn't like to say it's a friendship, but it's a relationship built in trust where you trust your physician and or whoever your provider may be, helping with your diabetes and you understand that they have your best interests at heart. Yeah, absolutely. So just reiterating, I talk about self-advocacy all the time. Put your self-advocacy hat on and know what you need from those appointments and care providers. Don't be afraid to ask. The worst that they can say is, eh, no, or maybe that's not right, or let's take another approach and that's okay, then you try something else that might work for you. We have one question. Is there a correlation between inflammation, insulin resistance, and heart disease? Yes, simple answer is yes. Insulin resistance is the underpinning of most of what we see in type 2 diabetes and there's a very close correlation between that inflammation and it's quite a complex, long answer, which we probably don't have time to do in one minute, but the simple answer is yes, and I think type 2 diabetes is a chronic inflammatory condition driven by insulin resistance and associated with cardiovascular risk. Thank you so much, Dr. Sienkamp. I know you have to hop on to the next live, so I'll let you go and I can wrap up with the audience and send them your way where you're going, but thank you for your information and for being a caring, knowledgeable endocrinologist. We are so happy to have doctors like you. Thanks very much, Nina. Bye. That's it for this episode of Your Diabetes. Thank you so much for listening to the pod. You can check the show notes for resources that we chatted about in this episode, and you can also visit diabestepod.com for a recap and the transcription of today's episode. As always, take care, and I'll talk to you in the next one.