Interview With ‘Conquer Your Diabetes’ Authors, Abrahamson and Chopra
By Hope Warshaw
Hope Warshaw interviewed Dr. Martin Abrahamson and Dr. Sanjiv Chopra about their new self-published book, Conquer Your Diabetes: Prevention – Control – Remission. Her interview explores the key premises and practical steps these authors recommend to live a healthy and fulfilling life with diabetes.
Conquer Your Diabetes: Prevention – Control – Remission covers many topics in just over two hundred pages of readable text and diagrams. The authors speak from their experiences and share recent research on an array of diabetes-related topics. This includes common subjects, such as insulin therapy, diabetes technologies, and complications; it also includes rarely covered topics, like bariatric surgery, musculoskeletal problems, and liver disease. To reinforce important management principles, they also add stories and experiences from people with diabetes they have cared for.
Dr. Martin Abrahamson began his medical career in Cape Town, South Africa. He is a renowned endocrinologist with an expertise in diabetes. He serves as an Associate Professor of Medicine at Harvard Medical School and was Senior Vice President and Chief Medical Officer at Joslin Diabetes Center for 10 years.
Dr. Sanjiv Chopra graduated from the All India Institute of Medical Sciences in New Delhi, India. He is Professor of Medicine at Harvard Medical School and was the Faculty Dean for Continuing Education at Harvard Medical School for 12 years.
Together Drs. Abrahamson and Chopra co-direct the Division of Continuing Medical Education for the Department of Medicine at Beth Israel Deaconess Medical Center in Boston, which offers courses nationally and internationally.
Hope Warshaw: What motivated each of you to write this book now?
Martin Abrahamson and Sanjiv Chopra: We have been caring for people with diabetes for almost 40 years and have been inspired by many of them. We also felt that due to a myriad of technological advances and pharmacological treatments, together with appropriate lifestyle modification, people with diabetes can lead full and rewarding lives. Our hope is that this book meets the request we’ve gotten for a comprehensive resource on diabetes.
Warshaw: How, in your view, is this book different from other books about diabetes care?
Chopra: This book has 25 chapters. It’s comprehensive and includes stories of people with diabetes that we believe will resonate and inspire readers. We included chapters on the latest medications for type 1 and type 2 diabetes, the role of the gut microbiome, different eating plans and patterns, bariatric surgery, and even the promise of stem cells to [potentially] cure type 1 diabetes. New technologies, how to prevent complications, vaccinations, and more topics are covered as well.
Warshaw: You use the words “prevention” and “remission” in the subtitle. What do these terms mean in relation to type 1 diabetes and type 2 diabetes?
Abrahamson: While we can identify people who are at very high risk for developing type 1 diabetes, there is currently no way to prevent it. However, there is some promising research with new medications, such as Teplizumab, a novel medication that modulates the immune system. This could change the landscape within five years or so. Regarding remission of type 1 diabetes, stem cell therapy is currently being studied in clinical trials.
Type 2 diabetes can be prevented. We know that losing about seven percent of one’s starting body weight and keeping most of those pounds off, coupled with regular exercise, reduces the risk of developing type 2 diabetes in people with prediabetes by a staggering 58% in the large US-based Diabetes Prevention Program study. Twenty-two years after the study was completed, there was a notable 25% risk reduction in the people who were originally in the lifestyle modification group of the study. Remission of type 2 diabetes, at least for several years, can be achieved with a relatively small amount of weight loss – either with a healthy eating plan and glucose-lowering medication, or following bariatric surgery.
Warshaw: You use the term, “mastering diabetes.” What do you mean by this phrase?
Abrahamson: Our book includes stories of many people who have done just this: “mastered their diabetes.” They have maintained excellent glucose management by virtue of lifestyle changes, their food choices and eating habits, and use of prescribed medications. They have not let diabetes define who they are, but rather have led fulfilling and rewarding lives, often living well into their nineties.
Warshaw: What, in your minds, are the most significant learnings or discoveries over the last couple of decades regarding type 1 diabetes or its management?
Abrahamson: The major advances for people with type 1 diabetes include new insulins that more closely match the way a person without diabetes secretes insulin from their pancreas and better insulin delivery systems (like smart pens and caps and insulin pumps, including the evolution towards hybrid-closed loop and automated insulin delivery systems). Plus, more sophisticated glucose monitoring technologies, like continuous glucose monitors and sensors that can measure glucose 24 hours a day, without the need for finger sticks to check blood glucose, are other advances affecting type 1 diabetes management.
Warshaw: What, in your minds, are the most significant learnings or discoveries over the last couple of decades regarding type 2 diabetes or its management?
Chopra: Many scientific discoveries are totally unforeseen. For example, following bariatric [weight loss] surgery, some people with type 2 diabetes can reverse their type 2 diabetes within a few weeks, even before there has been significant weight loss, if they are in the early years after diagnosis. This seems to be caused by a change in composition of the gut microbiome and in the hormones that regulate digestion and insulin secretion.
Abrahamson: In addition, there have been major advances in the medications used in type 2 diabetes management that lower glucose and can also assist with weight loss without risk of hypoglycemia. Some of these medications also have benefits on the heart and blood vessels.
Warshaw: The gut microbiome is receiving a lot of attention today. What information can you provide about the role of the gut microbiome in type 1 diabetes and/or type 2 diabetes, along with steps people can take to improve the health of their gut microbiome?
Chopra: The gut microbiome influences our health, including the onset of obesity, type 2 diabetes, arthritis, Alzheimer’s disease, and some autoimmune diseases. The composition of our gut microbiome is influenced by how you were born – C-section vs. vaginal delivery, where we live geographically, whether we are given antibiotics during infancy, the foods we eat, and the medications we take. Most research on this subject is preliminary, but there is no question that in the next five years we’ll have more insight and therapies to favorably alter the gut microbiome.
Warshaw: You touch briefly on the role of mental health in diabetes care. You also discuss the importance of behavior change to manage diabetes. Can you elaborate on steps people can take to conquer the many mindset aspects of conquering diabetes?
Abrahamson: Diabetes is challenging – once diagnosed it is a lifelong condition. It is not surprising that people will, at some stages in their lives, feel overwhelmed by these challenges. We know that up to 50% of people with diabetes can develop depression, and we also know that less than 50% of people with depression seek help or are diagnosed. Fortunately, there are many actions people can take to prevent or treat this – exercise, medications, and support groups are a few examples.
Warshaw: You cover the myriad complications of diabetes, from eye problems to heart and blood vessel diseases, to kidney and liver diseases. Can you offer readers an optimal approach to live a long and healthy life with diabetes, including preventing or delaying complications?
Abrahamson and Chopra: There is ample evidence that good glucose management following the diagnosis of diabetes significantly reduces the risk for the development or even progression of early complications. In addition, diabetes can be accompanied by high blood pressure, abnormal lipid levels, and liver disease. All of these conditions need to be addressed and managed over time.
Warshaw: You write about the importance of individualized care for all people with diabetes and note that there is not a one-size-fits-all approach. Can you offer readers guidance on how best to advocate for themselves to get individualized as well as optimal diabetes care through the years?
Abrahamson: Every person is unique. In our book we address the complete range of approaches to optimal health. We include a checklist and a vaccination schedule, as well as links to important resources. We provide readers with ways to empower themselves. We hope the many stories embedded in the pages of the book will be a source of inspiration.
Warshaw: What should be go-to resources for people with diabetes to stay up to date on new knowledge about diabetes and its management?
Chopra: We provide important links in our book. We encourage people with diabetes to ask their healthcare providers about new advances or new resources at each visit.
Warshaw: Where can diaTribe readers purchase your book?
Abrahamson: Our book is now available on Amazon, and Barnes and Noble as a paperback and/or ebook. Just search for the title.
Warshaw: Thank you, Drs. Abrahamson and Chopra for writing this helpful resource for people with diabetes and their loved ones.