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Diabetes Prevention (transcript)
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(Announcer)
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(music)

(Dr. Salgo)
Welcome to Second Opinion, where each week our healthcare team solves a real medical mystery. When we close this file, in a half an hour from now, you’ll not only know the outcome of this week’s case but you’ll be better able to take charge of your own healthcare.  And doctors will be able to listen to patients more effectively.  I’m your host, Dr. Peter Salgo.  You’ve already met our special guests who are joining our primary care physician, Dr. Lisa Harris.  Lisa, nice to see you back.  Nobody on this team knows the case except me, and I’ve got it right here.  So let’s go and talk about it, shall we.  Let me tell you a little bit about Dolores.  Dolores is fifty-four years young.  She’s married.  She has two teenage children and she works full-time.  She’s in her primary care physician’s office because she has gained a lot of weight and she can’t seem to stop gaining weight.  She also says she’s always thirsty.  She has to go to the bathroom a lot.  She’s in your office. What are you thinking?


(Dr. Harris)    
Well I’m concerned because the symptomatology that she has is a big warning flag for something, development of diabetes mellitus.  Of course we’d want to worry about thyroid disease and stress eating and all the other things that could be going on with her but we need to really sit down and get some more details about what’s going on with her.

 
(Dr.  Salgo)     
Well the weight here in the chart is recorded as going from 150 to 175, 25 pounds in two years.  She’s 5’6”.  They don’t have an actual BMI number in the chart but her physician says that it’s gone from healthy to high end of overweight.  She is a known hypertensive.  She has high blood pressure.  She’s under good control on a beta blocker and a diuretic for the past ten years.  Family history of diabetes, her dad has diabetes. She doesn’t smoke. She doesn’t drink.  And when measured in the office, her blood pressure is normal.

 
(Dr. Salgo)
Is she overweight?  She’s 5’6, 175?


(Dr. Harris)    
Yes she is.


(Dr. Salgo)
How do you know?


(Dr. Harris)    
Well, there’s a quick and easy way to figure that out. So in general at 5 feet it’s 100 pounds for women, and it’s 5 pounds for every inch above that.


(Dr. Salgo)
Reggie, you’re a cardiologist and you started studying obesity before it became the thing to do.  It became an epidemic or known as an epidemic in the United States.


(Reggie)          
Correct.


(Dr. Salgo)
Why your interest?  A cardiologist in.


(Reggie)          
Because most individuals who develop true obesity will have a cardiovascular problem associated with their obesity.  High blood pressure, atherosclerotic heart disease, heart disease, stroke, vascular problems.  All of these things will be the result of obesity. And since we’re in the middle of an obesity epidemic we’ve had a threefold increase in the last thirty years.  All the things that I just mentioned are increasing in epidemic proportions.

 
(Dr. Salgo)      
I’m watching Laura, and you know what she’s been doing. She’s going yes.

 
(Laura)
Nodding her head.


(Dr. Salgo)      
I understand this.


(Laura)
Been there.  Absolutely.


(Dr. Salgo)      
You’ve been there. Tell me about that.


(Laura)
Well what interests me is this woman sounds an awful lot like myself.  When suddenly I realized I need to get control.  For me it was the weight gain.  I said I don’t want to be this unhealthy person and went to the doctor and said, yes I’m overweight.  I have no idea what my blood pressure is.  I have no idea what my sugar levels are or.  But I want to know because I don’t want to become diabetic.  I don’t want to have high cholesterol.

 
(Dr. Salgo)      
What was your cholesterol?  What was your blood pressure?

(Laura)
 Well it was all high.

(Dr. Salgo)      
Well just for the record.  I mean before we go any further, its worth noting right, that you can be obese, have a normal cholesterol.  You can be rail thin and have a terrible cholesterol.  They don’t really track very well, do they?

(Reggie)          
They do tend to cluster, however.  You are absolutely correct.  You can have a high cholesterol and none of the other risk factors, but the reality, at least in this country is that when you have one you generally will acquire the others.  Because most of them are genetic as well as lifestyle related.  And if your lifestyle is one that supports high cholesterol, high blood pressure, overweight or obesity, then you generally cluster all these risk factors.  And the other important thing though is that most patients are, have no symptoms when they’re developing all of these things.  So they will tell you that they feel okay.

(Dr. Harris)    
And actually I’ll disagree with you a little bit.  What I’ve found is that patients are tired. And I know like for me, many of the viewers know that I am diabetic.  It was the, I didn’t lose the baby weight.  And I couldn’t get rid of that last baby weight and I started feeling really tired.  She came into the doctor because she was having symptoms, which tells us that she probably does have diabetes. 

(Laura)
And it’s interesting you say baby weight because I would say after having two children that’s exactly what it is.  You get stuck in this lifestyle and you don’t want to hear from that doctor you need to lose weight, because it’s hard to hear and it’s even harder to know what to do about it.

(Dr. Harris)    
What I hear from my patients is that they’re so busy.  You know, they have two children or more, and they have a job and they just don’t have time for themselves.

(Reggie)          
Right.

(Lisa)  
And so they do everything.  They don’t eat right because they don’t have time.  They don’t exercise because god knows they don’t have time for that. 

(Dr. Laurie)    
That’s it.

(Dr. Salgo)      
I want to tell you some more about Dolores.  Her resting pulse rate was 74 in the doctor’s office.  Her fasting glucose was 102.  Her glycosylated hemoglobin was measured previously and it was 5.2.  And on this visit it’s 5.8.  Her HDL cholesterol was 50.  Her uric acid, for whatever reason that was obtained, is 6.  It’s right here in the chart.  So let’s talk about the glycosylated hemoglobin for a second.  What is it?

(Dr. Harris)    
It’s a test by which, what happens when your blood sugar is elevated above normal the blood sugar attaches to the red blood cell.  The red blood cell has a life span of approximately three months.  So you get a general idea of the elevation of blood sugar.

(Dr. Salgo)      
If the glycosylated hemoglobin, if it’s elevated doesn’t that say there’s significant periods of time over a significant chunk of her history for the past three months.

(Dr. Harris)    
But it’s not.

(Dr. Salgo)      
Her sugar’s been too high.

(Dr. Harris)    
Her A1C is 5.8, so most primary care doctors are going to say that’s okay and I’m just. 

(Bob)  
And it’s not okay.

(Dr. Harris)    
I want to hear from Bob.

(Bob)  
5.8 percent means she’s been elevated for a while.  You don’t want to call it normal if it’s 5.8.  Hers probably ought to be 4.8. 

(Dr. Salgo)      
So that brings the obvious question.  What does it tell you about our patient?
Female Voice: 
She probably has diabetes and if she doesn’t have diabetes she’s going to get there very soon.

(Dr. Salgo)      
How soon?

(Bob)  
And maybe the real answer is it doesn’t make a lot of difference whether she’s a diabetic or not diabetic. The pre-diabetic state, that family history with diabetes, hypertension.  And that is a big iceberg below the water.  And as that iceberg gets above the water we call it diabetes but when it’s below the water it’s a huge cardiovascular risk. 

(Dr. Salgo)      
Well I’ll tell you what the doctor tells Dolores.  She says you’re on your way to having Type II Diabetes.  And again, just nail it.  What in this history, just point by point would have led the doctor to tell her that?

(Dr. Harris)    
Her hunger.  Her increase urination.  Her thirst.  Her borderline fasting blood glucose.  Her elevated hemoglobin A1C.

(Reggie)          
Her obesity.

(Dr. Harris)    
Her obesity.  Her hypertension.

(Dr. Salgo)      
I should have asked what doesn’t fit this pattern.

(Dr. Harris)    
Right.

(Bob)  
And.

(Dr. Salgo)      
You know we’ve gone this far.  We haven’t really gotten a definition of diabetes.  We know there’s Type I, Type II.  Somebody want to give me a bullet for each of these?

(Bob)  
Type I Diabetes, Peter, is an autoimmune disease where your beta cells that produce insulin become destroyed.  You can be skinny.  You can be fat.  It really is, has nothing more than you just lose beta cells.  You lose insulin producing cells.  Type II Diabetes is really characterized by resistance to the action of insulin.

(Dr. Salgo)      
Laura, when you’re sitting in the doctor’s office.  You’ve gone there in a panic.

(Laura)
Absolutely.  I left work and went to the doctor’s office. 

(Dr. Salgo)      
You did.  Were you worried about diabetes?

(Laura)
I was.  Yes.  I was worried about everything.

(Dr. Salgo)      
So let me ask the docs this.  If you’re saying, not seeing a doctor, not exercising contributes to the development of Type II Diabetes, are you blaming Dolores?  Is the old blame the patient game?  You got diabetes because you didn’t do what we told you. 

(Reggie)          
Well I think we have to recognize that part of what we’re seeing in this country is the result of the obesogenic environment we now have created.  Fast foods are prevalent.  The availability of healthy foods, although very easily obtained in some neighborhoods, are very difficult to obtain in other neighborhoods.  They’re more expensive.  We have ways of not exercising anymore.  We’ve eliminated things in our schools.

(Dr. Salgo)      
Let me interrupt you.  I think I’m hearing a yes.  I think I’m hearing that.
Multiple Voices:
No.

(Dr. Harris)    
She lives in a toxic environment. 

(Reggie)          
Yeah, she.  That’s exactly right. She lives in a toxic environment. She has some control over her environment but until we really recognize that we have to not only have to not only look at what individuals are doing but what’s the environment that they’re living in is doing.  Until we tackle both we’re going to continue to have these problems. 

(Dr. Harris)    
The answer to your question is no, we should not blame her.  That’s not even the issue.  The issue is you have this problem, what can we do to help you overcome it. 

(Dr. Salgo)      
So the answer that you’re giving me is it doesn’t matter, let’s fix it. 

(Dr. Harris)    
That’s right.

(Dr. Salgo)      
Alright.  Let me tell you more about Dolores.  She’s African-American.  And point of fact, does that make a difference in her diabetes risk? 

(Reggie)          
This is a complicated issue.  The easy answer is yes, minorities, particularly Native Americans, particularly Latinos, particularly African-Americans have a greater incidence of all these issues.  When you drill down a little deeper, however, you discover some other things that were kind of surprising.  For example, where you live geographically.  An African-American who lives in the south is going to have far more problems than an African-American who lives on the west coast.  An African-American or a Caucasian, for that matter, who lives in the south and is living in poverty, actually experiences the same incidence of all these problems as the general population in the south.  So it appears to not only be racially determined, culturally determined, genetically determined, but also you’re socio-economic status or your poverty rate.  And all of these things are interrelated. 

(Dr. Salgo)      
Now Laura, what did your doctor tell you to do?

(Laura)
My doctor told me to go home and this was after a lot of blood work had come back.  I got a phone call and it was actually a nurse and says, here’s your results.  We want you to low fat.  Eat low fat.  We want you to change your, just switch to whole grains and we’ll see you back in a few months and let’s see.  We’ll take the same blood test again.  So I said okay.  I can do that.  Surely I can do that.  Hang up and, you know, try to manage your way through that maze.  I said I have no idea what that means.

(Dr. Salgo)      
Dolores’ doctor says pretty much what you heard. 

(Laura)
Right.

(Dr. Salgo)      
I want you to lose weight.  Go do it.

(Laura)
Right.

(Dr. Salgo)      
In addition her doctor wanted her to start taking Metformin.  What’s that?

(Bob)  
Metformin is a drug that is used to lower glucose levels. 

(Dr. Salgo)      
It’s a diabetes drug?

(Bob)  
It’s a diabetes drug.  And now when someone is diagnosed with diabetes, instead of diet and exercise and exercise and diet, its diet and exercise plus Metformin.  But no question as Laura has seen.

(Laura)
I was going to ask that because.

(Bob)  
Exercise and diet is the most important. 

(Laura)
Right. Well there was a short discussion about medication and I asked do I need to go on medication. And the quick response was let’s try to control this through diet, which I was happy in hearing you say that.  I wouldn’t have wanted to mask what I was already doing, eating poorly with a medication.

(Reggie)          
The problem with what we’re discussing here is that we as a medical profession tend to treat obesity and diabetes as if it were a strep throat. 

(Laura)
Right.

(Reggie)          
Here’s the test result.   Let’s write a prescription.

(Laura)
And you’re done.

(Reggie)          
Patient’s going to take the prescription and everybody’s happy.  Where we need to really approach these problems as a chronic disease, which is what they are. So the proper way to manage this would have been to see a nutritionist.  To see somebody that will interview you to see where you are in your willingness to change your behavior, change your diet, look at the entire family because you can’t go into a household and eat healthy foods and everybody around you is continuing to participate in this toxic environment.

(Dr. Salgo)     
Well let me walk you through a few of these things, if I met.  Metformin is a diabetes drug.  Is her doctor basically saying to her, to Dolores, you’ve got diabetes, have Metformin.  Or is her doctor saying take Metformin so you don’t get diabetes?

(Lisa)  
There was a study that looked at a group of people that liked Dolores where on the diabetes expressway, going to get there or were likely to get there.  And some of them were given just Metformin and others were put on a very rigorous program to change their diet, impose exercise, and see if they can get them to lose some weight and control it that way.  And the people who did best, who had the lowest risk of developing diabetes were the people who lost weight through diet and exercise.  Metformin also worked in terms of preventing or postponing the development of diabetes for any of these people. 

(Dr. Salgo)      
So this is an insulin issue.  Either she doesn’t have enough or she’s resistant to what she’s got.  Why give Metformin?  Just give her insulin. Why not?

(Dr. Harris)    
Well insulin in of itself is not safe to just give to everybody.  And you can run the risk of hypoglycemia, a low blood sugar, which is more dangerous than having an elevated blood sugar.

(Dr. Salgo)      
What are the effects of diabetes we’re trying to prevent here?  Just lay it out for us just once. Somebody.

(Dr. Harris)    
Blindness.

(Bob)  
Numero, uno, is cardiovascular disease.

(Dr. Harris)    
Heart attack, stroke, blindness.

(Bob)  
But Lisa you’re right, you ask patients what.

(Dr. Harris)    
Kidney failure, amputations.

(Bob)  
What complication of diabetes they’re most likely to get. 

(Dr. Harris)    
Going blind.

(Bob)  
They’ll say blind.  Blindness.

(Dr. Salgo)      
So blindness is one.  Cardiovascular disease, what else?

(Bob)  
Well blindness is.

(Dr. Salgo)      
Kidney failure is another one. 

(Bob)  
But the biggest is cardiovascular. 

(Dr. Salgo)      
Bad stuff.  Let me tell you what Dolores is told.  Dolores and her doctor speak together and they discuss the benefits and the risk of the Metformin, in specific, and together they decide that she’s going to start taking Metformin.  What do you think the outcome is going to be?

(Dr. Harris)    
She’s going to have diarrhea. She’s going to stop taking it and if she doesn’t change her diet and she’ll be back with elevated blood.

(Dr. Salgo)      
You are a professional cynic. 

(Dr. Harris)    
I certainly am.  I see a lot of diabetics.

(Dr. Salgo)
Do you all agree?

(Lisa)  
Well you know I think it’s so easy for doctors to just pull the trigger on a medicine and feel like its strep throat.  Like this is penicillin, we’re done.  But it’s not like that at all.  It’s really on ongoing issue.

(Dr. Salgo)     
Can somebody give me a number?  How many Type II Diabetics are there in this country?  Do we know this number?

(Reggie)          
Yeah, about twenty-five million.

(Dr. Salgo)      
Twenty-five million.  Let me stop.

(Bob)  
And about a third don’t know it.

(Reggie)          
Let me tell you a parallel statistic that is equally disturbing.  Eighty percent, 8-0 percent of Type II Diabetics in this country are obese.  The problem I have with giving them Metformin without all the other stuff is that we’re treating their blood sugar and we’re not treating all the consequences of obesity. 

(Dr. Salgo)      
Alright.  Let’s just pause for a moment.  I want to sum up what we’ve been discussing and then we’ll pick it up from there, shall we.  Type II Diabetes, a huge problem in the United States and the numbers are rising dramatically.  It is a dangerous disease and people at risk need to be monitored regularly and treated early.  Alright, I can tell you a little bit more about Dolores.  Dolores starts her Metformin.  Three months later she’s still on it.  Her A1C, her glycosalated hemoglobin has gone from 5.8 to 5.2.  So it’s not enormous but it’s a change. The drug seems to be working, so is Dolores all better now.  Is her diabetes all gone?

(Dr. Harris)    
What are her triglycerides?  What are?

(Dr. Salgo)      
I don’t have that for you.

(Dr. Harris)    
You know, Reggie makes a very.

(Reggie)          
How about her weight.

(Dr. Harris)    
Yeah, her.

(Dr. Salgo)
I don’t have that either.

(Dr. Harris)    
That’s the important point.  So now we’ve addressed one small facet and have not addressed all the other risk factors that she had.  And it’s an issue.

(Dr. Salgo)      
With the drug affecting the A1C that we’ve seen.

(Dr. Harris)    
It’s not enough.

(Dr. Salgo)      
So the sixty-four trillion dollar question in this area of bailouts I guess it’s ((quazillion)) dollars.  Is did Dolores really have to go on a drug at all?  Wouldn’t it have been better simply to make lifestyle changes, lose your weight?  Wouldn’t that have been a better first step?

(Laura)
Can just lifestyle changes prevent diabetes from happening?  That’s what I would like to know.             

(Reggie)          
Not in all patients but certainly I think what we’re all saying is that lifestyle changes should be tried if the patient is compliant. 

(Dr. Salgo)      
Exercise.  Everybody’s just very glib about it.  Go do some exercise.  How much exercise?

(Dr. Harris)    
Go ahead.

(Lisa)  
In the study that was done that looked at this, a hundred and fifty minutes a week was what they did.

(Dr. Salgo)      
Thirty minutes a day, five days a week.

(Lisa)  
Five days a week. 

(Dr. Salgo)      
Okay.

(Dr. Harris)    
You don’t have to go out and join the latest, you know, gym with a thousand dollar membership to do this.  There’s a lot of things that you can do at home that will constitute exercise.

(Laura)
And I didn’t find that out from my physician.  I did some reading.  I mean again, I decided I needed to do something.  Even simply starting with twenty minutes walking, work up a sweat and be comfortable that you just worked up a sweat.

(Lisa)  
Working up a sweat is very important.  You know.  I tell patients that they have to glow.  They cannot just stroll.

(Dr. Salgo)      
If you were to give a one sentence description of a healthy diet to somebody, what would that be?

(Dr. Harris)    
A nine inch plate or smaller, half of which is non starchy vegetables. The other portion of it is protein and the other portion is carbohydrates.

(Dr. Salgo)      
Laura what do you?

(Reggie)          
The thing I would add to that is color.  You should have color.

(Group)          
Non white foods.  Non white foods.

(Dr. Salgo)      
Non white food. Dolores says I work full time. 

(Lisa)  
Right.

(Dr. Salgo)      
I got two teenagers.  They’re a handful.  I’m exhausted all the time.  Do you really expect me, she says, to have time. This is.  You know, she’s like.  You’ve read her mind.  Do you really expect me to have time to exercise and make healthy meals?

(Laura)
And in retrospect if you eat healthier you have more energy too.  So.

(Lisa)  
And you make time for things that are important too.

(Dr. Harris)    
And that’s the thing.  You have to get the patient’s permission to get, particularly women to take care of themselves.

(Dr. Salgo)      
How did you do this in one sentence or two sentences.  What did you do?

(Laura)
I changed the way I eat and I increased my exercise.

(Dr. Salgo)      
Did you buy a book?

(Laura)
I did. 

(Dr. Salgo)      
Which book?  You can go ahead and say it.

(Laura)
No.  I followed the South Beach plan and I read the book.  I’ll admit I’ve read it several times.  Even after three years and even after losing seventy pounds.

(Dr. Salgo)      
Now you’ve all talked about how big a problem diabetes is in terms of absolute numbers of patients in this country.  Let’s put it into twenty-first century, post tarp terms.  Bucks.  How much does it cost, diabetes in the United States each year?

(Lisa)  
Oh wow.

(Bob)  
Biggest cost of anything, seventy percent of people with myocardio infarction either have diabetes or pre-diabetes.  The pre-diabetics don’t really get counted in there but if they did it’s the most expensive disease around. 

(Reggie)          
I would add to that.  In the era of healthcare costs.  Everyone is concerned about healthcare costs.  The biggest healthcare costs are related to obesity, diabetes and congestive heart failure. 

(Dr. Salgo)      
Are you talking millions, billions, trillions?

(Reggie)          
Trillions.

(Dr. Salgo)      
Trillions of dollars. 
Male Voice2:  
And most of that is preventable, if we had lifestyle changes in our country.

(Dr. Salgo)      
Alright, so what do we do as a nation?  How do we turn back this tide of diabetes?  We all just go out and buy the South Beach Diet?  What do we do?

(Laura)
I’m fascinated by some of the things that you’ve said and really, being a teacher getting to the kids and, but it’s huge.  I see it every day.  You watch these kids come into your classroom who you know are on the path to unhealthy.  Who are not signing up for athletics?  We are going to the cafeteria and they’re only going through the snack line.  They’re buying the Fritos and the sugary drinks.  But then you see their parents come in and you see the exact same thing.

(Dr. Salgo)      
So better teaching.

(Dr. Harris)    
We have to consider mandating or legislating some changes in order to get people to wake up.  We are talking about a pandemic.  And we are talking about an incredible cost to society. 

(Reggie)          
There’s another approach to this.  And that is what is known as changing the public will.  We need to change the public’s will through recognition and education that this is a problem.  And then allow the public to demand these changes occur as opposed as doing them through legislation or regulation because that will not work.  If the public realizes how preventable these problems are, through lifestyle changes, environment, school, education, and all those things.  Only then do I believe we’ll get a change.

(Dr. Salgo)      
Dolores cannot change her genetics.  Her genes are what they are.  But let’s say she makes some modifications in her lifestyle.  And if she theoretically can get her weight down to let’s say 145.  Her fasting glucose down to 74.  I don’t know her two hour PC.  Her triglycerides to 44.  Get her HDL cholesterol to 58.  Uric acid 2.2.  Resting pulse 58. These are rational goals, just in terms of numbers.  What does that do to her risk?  Metformin or not Metformin.

(Reggie)          
Greatly diminishes it. 

(Bob)  
Most Type II Diabetics if they lose weight and exercise will no longer be Type II Diabetics. 

(Dr. Salgo)      
With or without Metformin?
Male Voice2:  
With or without Metformin. 

(Dr. Salgo)      
So I want to ask you this one question again before we stop, because the Metformin thing is the thing that’s sticking to me.  If you do all this to get back into the no longer Type II Diabetics, is the Metformin the answer or is it lifestyle?  And is Metformin really helping to prevent the development of diabetes?

(Reggie)          
Well I think lifestyle will prevent the diabetes.  I think Metformin will help control her glucose.  But her lifestyle changes, in most patients will do the same thing.

(Dr. Salgo)      
So don’t get diabetes.  And you can do, at least a big chunk of this prevention despite your genetics, if your lifestyle is the right one.

(Reggie)          
Absolutely correct.

(Dr. Salgo)      
Let’s pause for a minute and sum up what we’ve been discussing.  We’ll go on from there.  Prevention is the key.  Having an active lifestyle, eating better foods can really make a difference in your diabetes risk by preventing or at least slowing the onset of diabetes.  You can extend the length and the quality of your life because diabetes shortens it and makes the quality of your life less good.  Is that all far?  Let me ask you one quick question.

(Laura)
Sure.

(Dr. Salgo)      
Because we’re just about to leave.  How do you feel today compared to, let’s say, five years ago?

(Laura)
Oh can’t even compare.  I feel great. 

(Dr. Salgo)      
And I want to thank you for telling us that.  You know it’s not easy to come on national television and say I used to be really big.

(Laura)
Oh yeah.  I.  It’s.  I feel much more self confident.  I’ve always been self confident but I feel better.  I feel better about who I am. 

(Dr. Salgo)      
Diet and exercise.

(Laura)
And exercise.  But it.  You don’t have to kill yourself doing the exercise. 

(Dr. Salgo)      
And you’re not on Metformin right?

(Laura)
And I’m not on nothing.  Not on.  I’m on nothing. 

(Dr. Salgo)      
Congratulations.

(Laura)
Thank you.

(Dr. Salgo)      
Tremendous effort.  This is not easy to do.  Let me tell you before we leave a little bit about Dolores.  Two years later Dolores is still on Metformin, has not changed her lifestyle, Lisa.  You know cynic you may be but accurate you seem to have been.  She now has full blown diabetes.  Very quickly, how common is this scenario.  I know you’re going to say it’s common.  Right.

(Reggie)          
Very common.

(Dr. Harris)    
Very common.

 (Dr. Salgo)     
Is this a depressing way to end the broadcast or is it just facts are facts?

(Dr. Harris)    
No the fact is that we really need to make, do a better job of enforcing diet and exercise and lifestyle changes.  And that will make the difference.

(Dr. Salgo)      
Makes what you’ve done all the more impressive. Thank you so much for being here.

(Laura)
Thank you.

(Dr. Salgo)      
Thank you all for a great discussion.  Let’s sum up once more what we’ve been talking about.  Type II Diabetes is a huge problem in the United States and the numbers are rising dramatically.  It is a dangerous disease and people at risk should be monitored regularly and treated early.  Prevention is the key.  Having an active lifestyle, eating healthy foods can really make a difference in your diabetes risk.  You can prevent the onset of diabetes and by doing so you can extend the length and the quality of your life.  And our final message is this, taking charge of your health means being informed and having quality communication with your doctor.  I’m Dr. Peter Salgo, and I’ll see you next time for another Second Opinion. 

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