Podcast 2007 Show Notes

Episode #0040—September 7, 2007
Time: 00:26:28 | Size: 24.2 MB

Schmalfeldt: Welcome to episode 40 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt.

Coming up on this edition—September is National Cholesterol Education Month. I'll sit down for a chat with Dr. Griffin Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases to discuss how controlling your cholesterol is a vital component in preventing the cardiovascular disease that can come following a diagnosis of diabetes. Wally Akinso will be along with some good ideas on how you can better communicate with your doctor. For the first time in a decade, there's been a comprehensive update of the National Asthma Guidelines. And we'll take a look at some fascinating research we first reported on two years ago that talks about using saliva for diagnostic purposes, much in the same way we currently use blood and other tissues. But first, some new information that shows a change in how Americans get their information about health and cancer. That's next on NIH Research Radio.

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New Report Indicates Changes in How Americans Get Their Information about Health and Cancer

Schmalfeldt: Although the Internet remains a frequent first source for Americans seeking health care information, a new study indicates that the public's trust in online material about health has declined. At the same time, more folks are expressing confidence in the information they get from health care professionals. The report-Cancer Communication: Health Information National Trends Survey 2003 and 2005-is a survey done every other year and sponsored by the National Cancer Institute at the National Institutes of Health. Dr. Bradford Hesse, chief of the Health Communications and Informatics Research Branch at the NCI, explains the results.

Hesse: People look to their physicians first and foremost as a trusted source of information. They went to the Internet because that was their first choice, but when they got there, what we're finding is that they're not quite as convinced that the information they have is credible. In fact, it's driving them to go to their physicians that much more. So we're seeing an increase in people going to their physicians now than we saw from 2003, and an increase in trust in their physicians.

Schmalfeldt: Dr. Hesse explained why folks continue to use the Internet as their first source for getting health care info, even though they are trusting it less.

Hesse: In the beginning, I think the very first phase, people who were going online and getting access to health information online were doing it in sort of a self-advocating way, so they would go and try to fill in the gaps in any way they could. Providers are now recognizing that they can meet an important need by putting information out themselves that is vetted and credible for their subscribers and their clients and their patients to use. We're seeing slight increases from 2003 to 2005, but we're going to be seeing even more of that as time progresses.

Schmalfeldt: Use of the Internet as a source for cancer-specific information remained relatively unchanged during the study period. Yet, the number of people using the Internet to communicate with their healthcare provider or their provider's office-using e-mail to ask questions or set up appointments, for instance-increased from 7 percent in 2003 to 10 percent in 2005.

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Schmalfeldt: Where can you get information geared toward helping you communicate with your doctor? Wally Akinso has the details.

NIHSeniorHealth Offers Tips on How to Talk with Your Doctor

Akinso: How do you communicate with your doctor about a sensitive issue? What if you feel rushed during your appointment? How can you get the most out of your visit with your health care provider? Being able to communicate openly, comfortably and assertively with your doctor can help you make good health decisions and stay well. But some older people shy away from this approach and hesitate to ask questions or take the doctor's time. You can find techniques to communicate with your doctor by checking out the "Talking with Your Doctor" topic on the website NIHSeniorHealth.gov. The website is a joint effort of the National Institute on Aging and the National Library of Medicine. Dr. Judith Salerno NIA's Deputy Director said most people know that communicating with their doctor is important to their care, especially as they age and are more likely to have health conditions and treatments to discuss, but the key is to know how to have that conversation.

Salerno: We would like to encourage people to be assertive about their health care which means being prepared. After all you're part of the health care team and you're the key member of that team. Make list of the questions that you might have for your physician list your medications and any assistive devices like canes and walkers that you might use and not necessarily bring with you. Be prepared remember that your time with your physician is valuable time and maybe very limited so cut down on the small talk and get to the point of what is important for you and your doctor to discuss.

Akinso: Dr. Salerno said she's optimistic about how the tips on site will be received by the older community.

Salerno: I hope that looking at the information provided on this website will help people communicate with their health care providers openly comfortably and assertively so that they can make good health care decisions and they can take an active role in their own care.

Akinso: Once again the website is www.NIHSeniorHealth.gov. This is Wally Akinso at the National Institutes of Heath Bethesda, Maryland.

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Schmalfeldt: When we come back, I'll talk with Dr. Griffin Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases about why diabetes patients need to bone up on their ABC's. That's next on NIH Research Radio.

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Interview with DR. Griffin P. Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases

Schmalfeldt: Welcome back to NIH Research Radio. In the studio with us is Dr. Griffin P. Rodgers, Director of the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Rodgers, welcome aboard.

Rodgers: Good to be here.

Schmalfeldt: We're in the month of September here. It's National Cholesterol Education Month. And folks are going to be concentrating on ways to modify their diet, think about activities, ways to avoid heart disease. But it's not just cholesterol folks need to be worrying about this month. There are more than 20 million adults in the United States with diabetes, and that also puts them at increased risk for heart disease and stroke. Could you give us a bit of a primer on what happens to the human body that increases the risk for stroke and heart disease?

Rodgers: Absolutely. And your point is very well taken. There are over 20 million Americans in this country today with diabetes. That's seven percent of the population who are living with diabetes, and this puts them at great risk for developing cardiovascular diseases such as heart attack and stroke. In fact, two out of three people with diabetes will die of a heart attack or stroke. But it's important to keep in mind that it's not only important to regulate the blood sugar, but also the blood pressure and cholesterol—as you've indicated. Therefore, it's important in the campaign we have out for people with diabetes to know their ABC's.

Schmalfeldt: What are those ABC's that folks with diabetes need to consider?

Rodgers: It's extremely important for them to know their ABC's. The "A" stands for A1C, or hemoglobin A1C, which is a simple blood test to determine what the average blood sugar level is for the previous three months. The "B" stands for blood pressure and the "C" stands for cholesterol. In patients with diabetes, we like their A1C level to reach a target somewhere below 7. The blood pressure, of course, the target is known. But in people that have a concomitant diabetes we like their blood pressure values to be below 130/80. And then, finally, cholesterol. There's so-called "good cholesterol," there's "bad cholesterol". The "bad cholesterol" or the ldl, we like the target value for that ldl in patients with diabetes to be less than 100. When patients with diabetes go to their providers, we want them to ask them a few questions. "What are my ABC's?" "What should my goals for the ABC's be?" And "How can I help in reaching those targets that you've set?" Let me put in a little plug here, you can get more information about those targets.

Schmalfeldt: You go right ahead, that's what you're here for.

Rodgers: by visiting our website www.yourdiabetesinfo.org. Or you can call a toll free number, 1-888-693-NDEP and learn more about those ABC's from our National Diabetes Education Program, which is called "Control Your Diabetes For Life." It's a campaign that's been very effective.

Schmalfeldt: We'll make sure we have those links on the transcript of the podcast, which folks can also find online at www.nih.gov. This is all the workings of the NDEP—the National Diabetes Education Program. Tell us a little bit about that program and your efforts to increase general awareness about diabetes prevention.

Rodgers: Well, the National Diabetes Education Program was a program that is now celebrating its 10th anniversary. It was founded in 1997 following some major research showing that controlling one's blood sugar could quite substantially reduce many of the complications—the heart complications, the complications associated with blindness, associations with end-stage kidney disease. And based upon that evidence the NDEP came out with these awareness campaigns to control your diabetes for life. Subsequently we were involved in a study with patients who were in high risk for developing diabetes—a diabetes prevention program with clearly showed that a number of interventions—most notably, an intensive lifestyle adjustment could substantially reduce the risk in people at high risk of developing diabetes to go on to develop diabetes. And so, a part of the message of NDEP was not only how to control your diabetes if you have it, but if you're at high risk for it, how can you go about preventing the diabetes. And so, much of what you can read about in our campaign—either through the toll-free number I mentioned before or through that website—will tell you the simple steps on an individual basis, on a community basis or on a larger basis, to try to achieve those evidence-based objectives.

Schmalfeldt: It seems like there's more information about diabetes out there for general consumption by the public. Yet your own stats show that Americans with diabetes have increased from 17 million in 2002 to 20.8 million in the most recent numbers. To what do you attribute that increase in patients with diabetes?

Rodgers: There are a number of factors that have been associated with that increase. Number one, we know that the risk factors for diabetes are increasing age. And I think one major contributor to that is really the aging—the baby boomers in our populations getting older, which would increase that risk factor. A second major risk factor for diabetes is actually an increased propensity in certain racial and ethnic groups, and so I think a second factor contributing is really a change in the demographics of the United States that we're seeing today. Largely though, and no pun intended, a major contributor to that has been overweight—almost an epidemic of overweight and obesity that we're seeing in this country. But not only that, also the decrease in physical activity. So really it's those three factors that are sort of coming together now that are contributing to this increase in the number of patients. And that's sort of the bad news. The good news, though, is that there are things that can be done to diminish your chances of going on to develop diabetes or, in fact—if you have it—to diminish the likelihood that you'll develop these complications that we spoke about.

Schmalfeldt: Well, there's some good takeaway messages for the folks listening to this podcast. Actually a large portion of the battle, it would seem, would be managing those ABC's we talked about earlier. What are some of the tips you would suggest for our listeners to—if they don't have diabetes yet—to really increase the odds of never coming down with it?

Rodgers: There are certain things that you can certainly avoid. Smoking is one of them. Of course, we have to eat, but we don't have to smoke. So smoking doubles your risk for cardiovascular disease if you have diabetes, and even if you don't have diabetes it increases substantially. And so that's something that we certainly tell people to avoid. To manage, really, the ABC's and to reduce your risk of these complications, we want and encourage people to reach and stay at a healthy weight because again being overweight and obese is a risk factor. Get at least 30 to 60 minutes of physical activity each day. Being physically active such as dancing or walking, doing household chores most days of the week can really lower one's blood pressure, help one lose weight, and it has many other positive, beneficial attributes. People should eat foods that are low in saturated fats, trans fats or cholesterol. Minimize the salt or added sugar that one takes in. Eating more fiber, choosing grains or fruits and vegetables or dried peas or beans or other things that not only, in patients at high risk for developing diabetes, diminish their risk, but even in patients that have existing diabetes this can control a lot of their over all blood sugar control during the day. As I mentioned before, stop smoking because smoking increases these risk factors for cardiovascular disease. If you are on medication, take the medication as directed. Ask your doctor about taking a daily aspirin. And finally, ask your friends and family members to help you manage your diabetes. It's been often said that it sometimes takes a village. This is something that will really assist very greatly in being to achieve and maintain the goals that one sets for one's self if the friends and family members are also involved.

Schmalfeldt: Get your whole team involved, basically.

Rodgers: Absolutely.

Schmalfeldt: And of course all that information you shared with us, Dr. Rodgers, is on the National Diabetes Education Program web site—www.yourdiabetesinfo.org—and available on the telephone at 888-963-NDEP, where you can learn more about the ABC's of diabetes through the NDEP "Control Your Diabetes for Life" campaign. Anything else you'd like to add while you're here?

Rodgers: This is a project that is really an excellent example of a public/private partnership. We have over 200 public and private members involved in the NDEP. Of course, it's run largely by the NIH and Centers for Disease Control, but there are a number of participants. We try to make sure that the message that we get out, because there are so many media venues that people are bombarded with every day, we want to make sure that the message that they hear has been field tested, if you will. There's a lot of social marketing going into this. We have a number of groups making sure that the message that's being conveyed is a message that's likely to stick and resonate with people because, unfortunately, you won't be able to change peoples' behaviors if they don't hear what you're saying. When they go to the web site and to that toll free number that you mentioned, they will see practical examples of ways that people can very effectively make decisions that can improve their health. The overall goal of this program is really to reduce illness and death associated with diabetes and its complications.

Schmalfeldt: And there's the twofold approach of taking measures to keep yourself from developing the disease and how to manage the disease if you should happen to develop it. Dr. Griffin P. Rodgers, Director of the NIH's National Institute of Diabetes and Digestive and Kidney Disorders, thanks for being our guest today on NIH Research Radio.

Rodgers: Thanks for having me.

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Schmalfeldt: When we come back, information about the first comprehensive update of the National Asthma Guidelines in a decade. That's next on NIH Research Radio.

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National Asthma Guidelines Updated

Schmalfeldt: There's been a change in the official thinking about asthma. This update, announced by the National Heart, Lung and Blood Institute at the National Institutes of Health, represents the first comprehensive change to the asthma guidelines in a decade. The Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, provides new guidance for selecting treatment, based on a patient's individual needs and the level of asthma control. The report—also known as EPR-3—emphasizes that while asthma can be controlled, the condition can change over time and differs among individuals and age groups. That makes it important to regularly monitor the patient's level of asthma control, adjusting the treatment as needed. EPR-3 takes a new approach to assessing and monitoring asthma by using multiple measures of a patient's current level of impairment and future risk, emphasizing that some patients can still be at high risk for frequent exacerbations even if their asthma causes them few day-to-day problems. The report also confirms the importance of teaching patients how to self-monitor their asthma, to use a written asthma action plan—including instructions for daily treatment and how to recognize and handle it when asthma gets worse. Also in the report—using multiple approaches to limit exposure to allergens and other things that can make asthma worse, as well as information on other common conditions and how treating those conditions—such as stress, sinusitis, overweight or obesity and obstructive sleep apnea, may also help improve control of a patient's asthma. For more information on these and other changes to the National Asthma Guidelines, log on to www.nhlbi.nih.gov.

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Schmalfeldt: Finally, a fascinating story we first aired in 2005 about how it may be possible to diagnose many diseases—not with a blood test—but with your saliva. Calvin Jackson has the report.

Lab on a Chip: Salivary Diagnostics

Jackson: Most people are familiar with the concept of going to a doctor and having blood drawn to study various markers, such as cholesterol or the level of sugar in their blood. But researchers have found that many of the substances that can be analyzed in blood can also be detected and analyzed using salvia. Speaking at a lecture in the 2005 Medicine for the Public lecture series, Dr. Lawrence Tabak, director of the National Institute of Dental and Craniofacial Research, says there are many instances where using salvia as the diagnostic medium of choice would make sense.

Tabak: "So for example, if you have individuals who are very infirmed, if you have a need to do collection within the community, one day with appropriate tests if people wanted to monitor themselves in their own home—it might be more reasonable to use salvia rather than blood in those cases. What we are trying to do is we're trying to come to a day where we would have small devices that would be inserted in the mouth that will allow for a continuous surveillance of different markers of health and disease. So that rather than waiting to go to a physician or a dentist for a particular test—you would in fact have continuous feedback—a sort of a health surveillance if you will. Bioengineers are working very hard with the oral biologists and are coming up with devices that are smaller and smaller. So I think that this small lab on a chip inserted in the mouth is not that far off—certainly within the next decade."

Jackson: Salivary diagnostics could have benefits far beyond medicine and dentistry as well. Law enforcement agencies could employ saliva tests in the field to determine rapidly whether a person is intoxicated or has recently used illegal drugs. These tests may also be beneficial in determining exposures to environmental, occupational, and biological substances. This is Calvin Jackson, the National Institutes of Health, Bethesda, Maryland.

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Schmalfeldt: And with that, we come to the end of this episode of NIH Research Radio. Please join us on Friday, September 21st when episode 41 of NIH Research Radio will be available for download. These stories are also available on the NIH Radio News Service website. www.nih.gov/news/radio. Our daily 60-second feature, NIH Health Matters is heard on radio stations nationwide, as well as on XM Satellite Radio, the HealthStar Radio Network and online at www.federalnewsradio.com. If you have any questions, comments or suggestions, please feel free to contact me. the info is right there on the podcast web page. That e-mail address ws159h@nih.gov—once again, our e-mail address is ws159h@nih.gov. I'm your host, Bill Schmalfeldt. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland. an agency of the US Department of Health and Human Services.

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