Dr. Samuel Dagogo-Jack, UTHSC professor, is an international expert in diabetes. Photography by Lance Murphey

Dodging Diabetes

By Dena L. Owens

UTHSC professor Samuel Dagogo-Jack focuses on prediabetes

You’ve heard it before – exercise and healthy eating habits can lead to a better quality of life. But can you avoid a chronic disease like diabetes if it runs in your family?

“Yes, you can,” says Dr. Samuel Dagogo-Jack.

Type 2 diabetes mellitus – adult-onset diabetes – affects the way your body converts digested food into energy. The disease manifests as a result of genetic influence, improper diet and insufficient exercise. Signs of diabetes include frequent urination, fatigue and thirstiness. But symptoms may not develop for years, says Dagogo-Jack, professor of medicine and chief of the Division of Endocrinology, Diabetes and Metabolism at the UT Health Science Center (UTHSC).

“The good news is diabetes and related health complications can be prevented or delayed, even if you have the genetic trait for the disease,” he says.

In a recent study, nearly 490,000 diabetes cases were reported in Tennessee, a massive increase from 335,000 in 2001. How can we protect ourselves?A native of Nigeria, Dagogo-Jack is recognized nationally and internationally for his work in endocrinology, specifically diabetes. The expert came to UTHSC in 2001 after working 10 years at Washington University in St. Louis. He also serves as director of the Endocrinology Fellowship Training Program and director of the Clinical Research Center, and he is the A.C. Mullins Professor in Translational Research. He is a member of the National Board of Directors for the American Diabetes Association.

Dagogo-Jack is the principal investigator of a study called Pathobiology of Prediabetes in a Bi-racial Cohort or POP-ABC. The project examines the development and prevention of prediabetes, the precursor to diabetes. The Memphis area, as well as the entire state of Tennessee, has high rates of prediabetes and diabetes, and Dagogo-Jack hopes study findings eventually will lead to a decrease in the disease.

In prediabetes, the blood sugar or glucose range is above normal but not at diabetic levels. Elevated levels signal a risk for diabetes. Blood glucose level is measured by a simple blood test performed after a patient fasts overnight.

The POP-ABC study was born after a national study found African-Americans and Caucasians progress from prediabetes to diabetes at the same rate. This was perplexing for Dagogo-Jack, since African-Americans contract diabetes at twice the rate of Caucasians. Compelled to learn more, Dagogo-Jack hypothesized that the answers must lie in the stage between normal blood sugar range and prediabetes.

The $3.3 million study is funded by the National Institutes of Health, the American Diabetes Association and the NIH Office of Minority Health.

Does Race Matter?

From 2006 to 2009, nearly 400 participants – half Caucasian and half African-American – were recruited for the POP-ABC clinical trial. Participants were required to have at least one parent with diabetes and were tested to verify a normal blood sugar range.

Participants have been evaluated every three months to determine how their blood sugar and metabolic systems function. Investigators assess each participant’s weight, body fat distribution, energy expenditure, eating habits and insulin sensitivity, resistance and secretion levels.

“My stepfather died from complications with diabetes, and my mother and brother have the disease,” said Patricia Hill, a UTHSC employee who volunteered for the study. “Not only has the study increased my awareness of steps I can take now to avoid diabetes, it helped me to tackle other issues with my health that were unknown to me. The study’s frequent checkups are a true lifesaver, and I encourage anyone to look for and join clinical trials where they live. Early detection is the key.”

Two key findings will result from the study:

1. Rate of progression from normal blood sugar to prediabetes by race among participants with similar blood glucose levels and the criteria of having at least one parent with diabetes. This will answer the question, “Does race matter if diabetes is in your bloodline?”

2. Factors that trigger a progression to prediabetes and factors that help participants maintain normal blood sugar levels. Aspects such as weight gain, food intake and exercise levels will be reviewed, along with changes in insulin sensitivity and secretion, body fat and metabolic function as related to increased blood sugar rates.

The POP-ABC study is the first to examine the occurrence of prediabetes as an end analysis versus the occurrence of full-blown diabetes. This allows Dagogo-Jack and his team of researchers to plan interventions to prevent prediabetes and diabetes in follow-up studies.

“The initial phase of the study established that prehypertension is prevalent among the offspring of diabetic persons. Therefore, preventing prediabetes may also stall or prevent prehypertension, the precursor to high blood pressure,” Dagogo-Jack says.

Complete findings will be published after the study ends in March.

Tips for Avoiding Prediabetes/Diabetes

Nationwide, cases of type 2 diabetes are increasing at alarming rates. More than 26 million Americans have type 2 diabetes, and an estimated 79 million have prediabetes, according to a current survey by the Centers for Disease Control and Prevention. In Tennessee, nearly 490,000 diabetes cases were reported, a massive increase from the 335,000 cases reported for the state in 2001. So, how can we protect ourselves?

“The solution to a diabetes epidemic is not found in a pharmacy or in a bottle but resides in an individual’s ability to change his or her lifestyle,” Dagogo-Jack says.

For protection against prediabetes or diabetes, Dagogo-Jack refers to the Diabetes Prevention Program: http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/. The national study recommends the age-old advice of eating a balanced diet and exercising regularly as the best defense against diabetes.

What you can do to protect yourself:

  • Walk 30 minutes per day for five days each week. Previous national studies indicate a 60 percent reduction in diabetes among prediabetic patients who follow this regimen.
  • Lower your sugar intake and use sugar substitutes approved as safe and effective by the U.S. Food and Drug Administration. These include aspartame and sucralose-based artificial sweeteners such as Splenda®.
  • Lower your intake of carbohydrates with high starch content such as potatoes, refined pasta, white bread, corn and desserts. Select foods made of complex whole grains such as whole grain pasta, oats, breads or rolls, which provide high fiber content as well as protection against cancer and high cholesterol. Also, legumes are great sources of fiber, protein and other important nutrients.
  • Commit to a balanced diet as prescribed by the U.S. Department of Agriculture. Details are found at: www.choosemyplate.gov. The USDA recommends that a meal plate consist of 50 percent fruit and vegetables, 25 percent whole grains and 25 percent protein.
  • Have an annual physical exam that includes testing your blood sugar level.
  • Identify and participate in diabetes clinical trials at reputable academic health institutions where clinical and laboratory monitoring takes place. Clinical trials are usually offered at no cost to the patient.

For more information, visit the American Diabetes Association website at www.diabetes.org.

“Diabetes can skip generations and siblings and can occur at any time,” Dagago-Jack says. “It can be asymptomatic, and if you don’t know your parental history and don’t get tested, you can walk around with undiagnosed diabetes.”