Pathobiology and geocoding: A community diabetes plan

By Justin Coby - Guest Columnist

The quality in which healthcare providers approach the chronic disease state management of their patients will inevitability be tested over time. In fact, it’s in the name. Chronic diseases include those that individuals might have to manage for the rest of their lives. Think of diabetes, hypertension, high cholesterol, and pulmonary disease, just to name a few.

In Miami County, the most heinous killer of our community is cardiovascular disease followed by respiratory disease in a distant second. The development of cardiovascular disease is closely linked to both diabetes and hypertension; however, diabetes takes the proverbial cake.

According to the American Heart Association, at least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16 percent die of stroke. Also, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.

So, the question is, can we as a community find and stop these diseases in those affected before it is too late? I think it’s worth a shot.

Before we go there, though, we need to talk a little pathobiology. Biochemist, Michael Brownlee, gave a 2004 Banting Lecture (a lecture named after the man that discovered insulin), entitled, The Pathobiology of Diabetic Complications. Cutting to the chase here, he posed that the reason for complications in a body due to diabetes can be attributed to one “unified mechanism”.

In his lecture, Brownlee points to the overproduction of a very volatile free radical, superoxide, by the mitochondrial electron transport chain (powerplants to the cells of our bodies) as the cause of further complications. In other words, there is a direct link between high blood sugar and oxidative stress in the human body, and the longer an individual unknowingly walks around with uncontrolled high blood sugar the worse the damage.

Here lies the problem though, many folks slowly creep into Type II diabetes and have no clue that anything is wrong. Patients find out that they are a diabetic after the heart attack or after the stroke, when the damage has already been done. How do we find these ticking time bombs and defuse before explosion?

Now that leads us to geocoding. Since 2005, a lot of attention has been placed on Geographic Information Systems (GIS), utilized in the healthcare world as an innovative and crucial tool for analyzing relationships between public health data and environment. For the most part, these systems have focused on more macro level data sets and disease clustering (or places where certain disease states seem to pocket) than finding the smaller links. Having said this, the concept really does make us think about community health and implications of preventative health.

Putting these two concepts together, pathobiology and geocoding, we here at Health Partners Free Clinic decided to quietly put a model together. Nearly a year ago, we partnered with the Wright State University Master of Public Health program and asked them to do some community analysis for us in the cities within Miami County. After months of data collection and on-site investigation, a cohort from the first city chosen presented on their findings.

We had hypothesized, based off research, that areas in the county of high food insecurity (lack of fresh affordable foods within attainable distance) would also be hot spots for diabetes. Knowing all this, we asked the cohorts to search out these areas and find organizations (churches, soup kitchens, businesses, etc.) that might be willing to partner with the clinic to create solutions.

Through our partnership with WSU, we have had this analysis run on two cities in the County and two more cohorts are currently working on more. Also, we have found three different locations of high food insecurity and partners in those areas. Currently, the clinic has three monthly sites where we have set up outreach screenings to take blood pressure and blood sugars of community residents. The three sites today are all soup kitchen programs, which have been terrific to work with.

Now that we have a plan for finding individuals in our community walking around with dangerously high blood sugar levels, what are we doing to fix the problem? With expanded walk-in hours, available primary care providers, prescription medications (including insulin), lab work, and pharmacist intervention at our finger tips, we get to work fighting the diabetes together with these folks. Sometimes all it takes is some education and access to quality foods. Other times intensive therapies over months or years are utilized just to get these blood sugars controlled.

What we know better today from all this is that the complications due to uncontrolled diabetes waits for no one. We have a plan and it’s time to get to work.

By Justin Coby

Guest Columnist

Justin Coby, PharmD, has been affiliated with Health Partners Free Clinic as a volunteer pharmacist since 2007, and was appointed executive director in 2012.

Justin Coby, PharmD, has been affiliated with Health Partners Free Clinic as a volunteer pharmacist since 2007, and was appointed executive director in 2012.